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Preferred method of therapy for patients with early-stage high-grade neuroendocrine carcinoma of the cervix

ABSTRACT: High-grade neuroendocrine carcinoma of the uterine cervix (HGNECC) is a rare and overly aggressive malignancy. Due to its rarity, there is no standard treatment. A majority of early-stage patients receive radical hysterectomy and lymph node dissection (RH+LND), followed by adjuvant chemotherapy. To explore the most suitable methods of therapy, a multicenter retrospective review of HGNECC patients was conducted. A total of 133 patients (I-IIA, FIGO 2009) treated from March 2003 to September 2018 were enrolled in this study. The 5-year DFS and OS rates for stages IB and IIA were 44.8% and 39.5%, and 53.8% and 39.6%, respectively. The median DFS and OS for stages IB and IIA were 41 months and 12 months, and 63 months and 45 months, respectively. The RH+LND surgery procedure was associated with a significantly better DFS (P=0.015) and OS (P=0.006), while the bilateral salpingo-oophorectomy (BSOE) was also associated with a better OS (P=0.023). The efficacy of paclitaxel-platinum (TP/C) adjuvant chemotherapy regimens need to be confirmed using clinical trials, especially for tumors with a diameter of >4 cm (P=0.0005). Therefore, the RH+LND+BSOE procedure was recommended for HGNECC patients at stages IB-IIA. TP/C is an alternative chemotherapy regimen that results in optimal survival. Moreover, a tumor diameter of >4 cm, LNM, DSI, and LVSI were confirmed as high-risk factors for worse DFS and OS. Patients without risk factor, 1 or 2 or 3 risk factors, and 4 risk factors had significantly different DFS and OS values.

SUBMITTER: Zhang Y

PROVIDER: S-EPMC8493402 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNeuroendocrine carcinoma of the cervix (NECC) is a rare variant of cervical cancer. The prognosis of women with NECC is poor and there is no standardized therapy for this type of malignancy based on controlled trials.MethodsWe performed a systematic literature search of the databases PubMed and Cochrane Central Register of Controlled Trials to identify clinical trials describing the management and outcome of women with NECC.ResultsThree thousand five hundred thirty-eight cases of NECC in 112 studies were identified. The pooled proportion of NECC among women with cervical cancer was 2303/163470 (1.41%). Small cell NECC, large cell NECC, and other histological subtypes were identified in 80.4, 12.0, and 7.6% of cases, respectively. Early and late stage disease presentation were evenly distributed with 1463 (50.6%) and 1428 (49.4%) cases, respectively. Tumors expressed synaptophysin (424/538 cases; 79%), neuron-specific enolase (196/285 cases; 69%), chromogranin (323/486 cases; 66%), and CD56 (162/267; 61%). The most common primary treatment was radical surgery combined with chemotherapy either as neoadjuvant or adjuvant chemotherapy, described in 42/48 studies. Radiotherapy-based primary treatment schemes in the form of radiotherapy, radiochemotherapy, or radiotherapy with concomitant or followed by chemotherapy were also commonly used (15/48 studies). There is no standard chemotherapy regimen for NECC, but cisplatin/carboplatin and etoposide (EP) was the most commonly used treatment scheme (24/40 studies). Overall, the prognosis of women with NECC was poor with a mean recurrence-free survival of 16 months and a mean overall survival of 40 months. Immune checkpoint inhibitors and targeted agents were reported as being active in three case reports.ConclusionNECC is a rare variant of cervical cancer with a poor prognosis. Multimodality treatment with radical surgery and neoadjuvant/adjuvant chemotherapy with cisplatin and etoposide with or without radiotherapy is the mainstay of treatment for early stage disease while chemotherapy with cisplatin and etoposide or topotecan, paclitaxel, and bevacizumab is appropriate for women with locally advanced or recurrent NECC. Immune checkpoint inhibitors may be beneficial, but controlled evidence for their efficacy is lacking.

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Preferred method of therapy for patients with early-stage high-grade neuroendocrine carcinoma of the cervix

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