1
|
Xiang X, Zhang Y, Hua K, Ding J. Impacts of ovarian preservation on the prognosis of neuroendocrine cervical carcinoma: a retrospective analysis based on machine learning. World J Surg Oncol 2023; 21:146. [PMID: 37173713 PMCID: PMC10176922 DOI: 10.1186/s12957-023-03014-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/04/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Neuroendocrine cervical carcinoma (NECC) is a rare but aggressive malignancy with younger patients compared to other common histology types. This study aimed to evaluate the impacts of ovarian preservation (OP) on the prognosis of NECC through machine learning. METHODS Between 2013 and 2021, 116 NECC patients with a median age of 46 years received OP or bilateral salpingo-oophorectomy (BSO) and were enrolled in a retrospective analysis with a median follow-up of 41 months. The prognosis was estimated using Kaplan-Meier analysis. Random forest, LASSO, stepwise, and optimum subset prognostic models were constructed in training cohort (randomly selected 70 patients) and tested in 46 patients through receiver operator curves. Risk factors for ovarian metastasis were identified through univariate and multivariate regression analyses. All data processing was carried out in R 4.2.0 software. RESULTS Among 116 patients, 30 (25.9%) received OP and showed no significantly different OS compared with BSO group (p = 0.072) and got better DFS (p = 0.038). After construction of machine learning models, the safety of OP was validated in lower prognostic risk group (p > 0.05). In patients ≤ 46 years, no impacts of OP were shown for DFS (p = 0.58) or OS (p = 0.67), and OP had no impact on DFS in different relapse risk population (p > 0.05). In BSO group, regression analyses showed that later stage, para-aortic LNM, and parametrial involvement were associated with ovarian metastasis (p < 0.05). CONCLUSIONS Preserving ovaries had no significant impact on prognosis in patients with NECC. OP should be considered cautiously in patients with ovarian metastasis risk factors.
Collapse
Affiliation(s)
- Xuesong Xiang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Yunqiang Zhang
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China
| | - Keqin Hua
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
| | - Jingxin Ding
- Department of Gynecology, The Obstetrics and Gynecology Hospital of Fudan University, 128 Shen-Yang Road, Shanghai, 200011, People's Republic of China.
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, The Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
2
|
Kim C, Salvo G, Ishikawa M, Chen TC, Jhingran A, Bhosale P, Ramalingam P, Frumovitz M. The role of postoperative radiation after radical hysterectomy for women with early-stage neuroendocrine carcinoma of the cervix: A meta-analysis. Gynecol Oncol 2023; 170:328-332. [PMID: 36773379 DOI: 10.1016/j.ygyno.2023.01.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Neuroendocrine carcinoma of the cervix (NECC) is an aggressive disease with high rates of nodal disease spread even in seemingly cervix-confined disease. Many providers routinely prescribe postoperative radiation therapy in an effort to reduce recurrences despite a lack of supporting studies. The objective of this study was to determine recurrence and mortality in patients with early-stage NECC who had pelvic radiation after radical hysterectomy compared to those who did not receive radiation. METHODS We performed a meta-analysis of 13 unique studies that reported recurrence and/or mortality for patients with early-stage NECC who underwent radical hysterectomy with or without adjuvant radiation therapy. RESULTS In 5 studies that reported overall recurrence rates, 63 (52.5%) of 120 patients who received postoperative radiation recurred compared to 70 (37.8%) of 185 patients who did not (RR 1.21, 95% CI: 0.85-1.70, p = 0.29). In 5 studies that reported pelvic recurrence rates, there were 15 pelvic recurrences (12.5%) in the 120 patients who received postoperative radiation compared to 45 pelvic recurrences (24.3%) in the 185 patients who did not (RR 0.60, 95% CI: 0.34-1.08, p = 0.09). In 13 studies that reported mortality rate, there were 138 deaths (34.8%) in 396 patients who received postoperative radiation therapy compared to 223 (35.2%) in 632 patients who did not (RR 1.08, 95% CI: 0.75-1.56, p = 0.66). CONCLUSIONS The addition of routine postoperative radiation therapy in all patients with early-stage NECC after radical hysterectomy may reduce pelvic recurrences but does not appear to decrease overall recurrence or death. However, there may still be a role for postoperative radiation therapy in patients with additional high-risk pathologic factors.
Collapse
Affiliation(s)
- Catherine Kim
- Inova Fairfax Hospital, Obstetrics and Gynecology, Falls Church, VA, USA
| | - Gloria Salvo
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mitsuya Ishikawa
- National Cancer Center Hospital, Department of Gynecology, Tokyo, Japan
| | - Tze-Chien Chen
- MacKay Memorial Hospital, Division of Gynecologic Oncology, Taipei, Taiwan
| | - Anuja Jhingran
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Bhosale
- Departments of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preetha Ramalingam
- Departments of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael Frumovitz
- Departments of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
3
|
Virarkar M, Vulasala SS, Morani AC, Waters R, Gopireddy DR, Kumar S, Bhosale P, Lall C. Neuroendocrine Neoplasms of the Gynecologic Tract. Cancers (Basel) 2022; 14:1835. [PMID: 35406607 DOI: 10.3390/cancers14071835] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 01/11/2023] Open
Abstract
Simple Summary Neuroendocrine refers to the cells that synthesize and secrete messenger chemicals such as neuropeptides and amines. Neuroendocrine neoplasms (NENs) are aggressive tumors arising from neuroendocrine cells, with an annual incidence of 6.98/100,000 and a prevalence of 170,000 in the United States. Primary gynecologic NENs constitute ≤2% of female reproductive tumors. NENs of the gynecologic tract are associated with high recurrence rates and dismal prognosis, making their treatment challenging. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of NENs of the gynecological tract. Abstract Gynecological tract neuroendocrine neoplasms (NEN) are rare, aggressive tumors from endocrine cells derived from the neuroectoderm, neural crest, and endoderm. The primary gynecologic NENs constitute 2% of gynecologic malignancies, and the cervix is the most common site of NEN in the gynecologic tract. The updated WHO classification of gynecologic NEN is based on the Ki-67 index, mitotic index, and tumor characteristics such as necrosis, and brings more uniformity in the terminology of NENs like other disease sites. Imaging plays a crucial role in the staging, triaging, restaging, and surveillance of NENs. The expression of the somatostatin receptors on the surface of neuroendocrine cells forms the basis of increasing evaluation with functional imaging modalities using traditional and new tracers, including 68Ga-DOTA-Somatostatin Analog-PET/CT. Management of NENs involves a multidisciplinary approach. New targeted therapies could improve the paradigm of care for these rare malignancies. This article focuses on the updated staging classifications, clinicopathological characteristics, imaging, and management of gynecologic NENs of the cervix, ovary, endometrium, vagina, and vulva, emphasizing the relatively common cervical neuroendocrine carcinomas among these entities.
Collapse
|
4
|
Fehm T, Stübs FA, Koch MC, Mallmann P, Dannecker C, Dietl A, Sevnina A, Mergel F, Lotz L, Ehret A, Gantert D, Martignoni F, Cieslik JP, Menke J, Ortmann O, Stromberger C, Oechsle K, Hornemann B, Mumm F, Grimm C, Sturdza A, Wight E, Loessl K, Golatta M, Hagen V, Dauelsberg T, Diel I, Münstedt K, Merz E, Vordermark D, Lindel K, Wittekind C, Küppers V, Lellé R, Neis K, Griesser H, Pöschel B, Steiner M, Freitag U, Gilster T, Schmittel A, Friedrich M, Haase H, Gebhardt M, Kiesel L, Reinhardt M, Kreißl M, Kloke M, Horn LC, Wiedemann R, Marnitz S, Letsch A, Zraik I, Mangold B, Möckel J, Alt C, Wimberger P, Hillemanns P, Paradies K, Mustea A, Denschlag D, Henscher U, Tholen R, Wesselmann S, Beckmann MW. Diagnosis, Therapy and Follow-up of Cervical Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry No. 032/033OL, May 2021) – Part 2 with Recommendations
on Psycho-oncology, Rehabilitation, Follow-up, Recurrence, Palliative Therapy and Healthcare Facilities. Geburtshilfe Frauenheilkd 2022; 82:181-205. [DOI: 10.1055/a-1671-2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim This is an update of the interdisciplinary S3-guideline on the Diagnosis, Therapy and Follow-up of Cervical Cancer (AWMF Registry No. 032/033OL), published in March 2021. The
work on the updated guideline was funded by German Cancer Aid (Deutsche Krebshilfe) as part of the German Guideline Program in Oncology. The guideline was coordinated by the German
Society of Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) and the Working Group on Gynecological Oncology (Arbeitsgemeinschaft
Gynäkologische Onkologie, AGO) of the German Cancer Society (Deutsche Krebsgesellschaft, DKG).
Method The process used to update the 2014 S3-guideline was based on an appraisal of the available evidence using the criteria of evidence-based medicine, adaptations of existing
evidence-based national and international guidelines or – if evidence was lacking – on the consensus of the specialists involved in compiling the update. After an initial review of the
current literature was carried out according to a prescribed algorithm, several areas were identified which, in contrast to the predecessor version from September 2014, required new
recommendations or statements which would take account of more recently published literature and the recent appraisal of new evidence.
Recommendations The short version of this guideline consists of recommendations and statements on palliative therapy and follow-up of patients with cervical cancer. The most
important aspects included in this updated guideline are the new FIGO classification published in 2018, the radical open surgery approach used to treat cervical cancer up to FIGO stage IB1,
and the use of the sentinel lymph node technique for tumors ≤ 2 cm. Other changes include the use of PET-CT, new options in radiotherapy (e.g., intensity-modulated radiotherapy, image-guided
adaptive brachytherapy), and drug therapies to treat recurrence or metastasis.
Collapse
Affiliation(s)
- Tanja Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Frederik A. Stübs
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Martin C. Koch
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | | | | | - Anna Dietl
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anna Sevnina
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Franziska Mergel
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Laura Lotz
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Anne Ehret
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | | | | | - Jan Menke
- SHG-Kliniken Völklingen, Klinik für Radiologie, Völklingen, Germany
| | - Olaf Ortmann
- Arbeitsgemeinschaft Deutscher Tumorzentren, Germany
| | - Carmen Stromberger
- Charité – Universitätsmedizin Berlin, Klinik für Radioonkologie und Strahlentherapie, Berlin, Germany
| | - Karin Oechsle
- Universitätsklinikum Hamburg-Eppendorf, II. Medizinische Klinik und Poliklinik, Hamburg, Germany
| | - Beate Hornemann
- Universitätsklinikum Dresden, Psychoonkologischer Dienst, Dresden, Germany
| | - Friederike Mumm
- Medizinische Klinik und Poliklinik III und Comprehensive Cancer Center (CCC München LMU), Klinikum der Universität München, LMU München, München, Germany
| | - Christoph Grimm
- Abteilung für allgemeine Gynäkologie und gynäkologische Onkologie, Gynecologic Cancer Unit, Comprehensive Cancer Center, Medizinische Universität Wien, Wien, Austria
| | - Alina Sturdza
- Universitätsklinikum AKH-Wien, Klinik für Radioonkologie, Wien, Austria
| | - Edward Wight
- Universitätsspital Basel, Frauenklinik, Basel, Switzerland
| | - Kristina Loessl
- Universitätsklinik Bern, Klinik für Radio-Onkologie, Bern, Switzerland
| | - Michael Golatta
- Universitätsklinikum Heidelberg, Frauenklinik, Heidelberg, Germany
| | - Volker Hagen
- St. Johannes Hospital Dortmund, Klinik für Innere Medizin II, Dortmund, Germany
| | - Timm Dauelsberg
- Universitätsklinikum Freiburg, Klinik für Onkologische Rehabilitation, Freiburg, Germany
| | - Ingo Diel
- Praxisklinik am Rosengarten, Mannheim, Germany
| | | | - Eberhard Merz
- Zentrum für Ultraschalldiagnostik und Pränatalmedizin Frankfurt, Frankfurt am Main, Germany
| | - Dirk Vordermark
- Universitätsklinikum Halle (Saale), Klinik für Strahlentherapie, Halle (Saale), Germany
| | - Katja Lindel
- Städtisches Klinikum Karlsruhe, Klinik für Radioonkologie und Strahlentherapie, Karlsruhe, Germany
| | | | | | - Ralph Lellé
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Klaus Neis
- Frauenärzte am Staden, Saarbrücken, Germany
| | | | | | | | | | | | | | | | | | | | - Ludwig Kiesel
- Universitätsklinikum Münster, Frauenklinik, Münster, Germany
| | - Michael Reinhardt
- Pius Hospital Oldenburg, Klinik für Nuklearmedizin, Oldenburg, Germany
| | - Michael Kreißl
- Universitätsklinikum Magdeburg, Klinik für Radiologie und Nuklearmedizin, Magdeburg, Germany
| | - Marianne Kloke
- Kliniken Essen-Mitte, Klinik für Palliativmedizin, Essen, Germany
| | | | - Regina Wiedemann
- Fliedner Fachhochschule Düsseldorf, Pflegewissenschaft, Düsseldorf, Germany
| | - Simone Marnitz
- Universitätsklinikum Köln, Klinik für Radioonkologie, Cyberknife- und Strahlentherapie, Köln, Germany
| | - Anne Letsch
- Universitätsklinikum Schleswig-Holstein, Klinik für Innere Medizin II, Kiel, Germany
| | - Isabella Zraik
- Kliniken Essen-Mitte, Klinik für Urologie, Essen, Germany
| | | | | | - Céline Alt
- Wolfgarten Radiologie Bonn, Bonn, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
| | - Peter Hillemanns
- Medizinische Hochschule Hannover, Frauenklinik, Hannover, Germany
| | - Kerstin Paradies
- Konferenz onkologischer Kranken- und Kinderkrankenpflege (KOK), Germany
| | | | | | - Ulla Henscher
- Hochtaunus Kliniken, Frauenklinik, Bad Homburg, Germany
| | - Reina Tholen
- Deutscher Verband für Physiotherapie (ZVK) e. V., Germany
| | | | - Matthias W. Beckmann
- Universitätsklinikum Erlangen, Frauenklinik, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | | |
Collapse
|
5
|
Beckmann MW, Stuebs FA, Vordermark D, Koch MC, Horn LC, Fehm T. The Diagnosis, Treatment, and Aftercare of Cervical Carcinoma. Dtsch Arztebl Int 2021; 118:806-812. [PMID: 34755595 DOI: 10.3238/arztebl.m2021.0352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 08/16/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Approximately 4380 cases of cervical carcinoma were diagnosed in Germany in 2016. In women who had not participated in early detection programs, cervical carcinoma was usually already in an advanced stage at the time of diagnosis. Certified structures for care in conformity with the existing guidelines are available. METHODS The new German clinical practice guideline was revised with the participation of 50 medical societies under the expert guidance of the Guideline Program in Oncology, which includes the German Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF). A systematic literature review was conducted. Systematic reviews, meta-analyses, and randomized controlled trials (RCTs) were considered. RESULTS The histologic tumor stage and lymph-node stage are essential determinants of the treatment strategy. The main innovation regarding surgical treatment is the revival of open hysterectomy (overall survival [minimally invasive vs open hysterectomy]: 94.04% vs 99.4%; hazard ratio [HR]: 6.00; 95% confidence interval [1.77; 20.30]). In addition, for tumors measuring 2 cm or less, sentinel node biopsy is recommended rather than radical pelvic lymphadenectomy. MRI-guided brachytherapy is an obligatory component of radiochemotherapy (overall survival [radiochemotherapy with vs without brachytherapy]: 58.2% vs 46.2%, p<0.001). The standard palliative treatment consists of bevacizumab combined with a platinum-containing agent (overall survival: HR: 0.77 [0.62; 0.95]; p = 0.007). CONCLUSION Despite the introduction of new treatments, the outcome of patients with advanced cervical carcinoma has not much improved. In the surgical treatment of cervical carcinoma, the open approach is now favored. The sentinel node biopsy technique has become well established for the surgical staging of small tumors. Controlled trials are needed so that the outcome of women with cervical carcinoma, particularly in its advanced and metastatic stages, can be improved.
Collapse
|
6
|
Sağnıç S, Birge Ö, Bakır MS, Karadag C, Şimşek T. Clinicopathological Analysis of Neuroendocrine Carcinoma of the Uterine Cervix: A Single-Institution Retrospective Review of 9 Cases. Int J Surg Oncol 2021; 2021:8290659. [PMID: 34567803 DOI: 10.1155/2021/8290659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/28/2021] [Indexed: 12/05/2022] Open
Abstract
Aim To evaluate the clinicopathological features affecting the recurrence and survival of 9 cases of neuroendocrine cancer of the cervix. Method We retrospectively analyzed 9 cervical neuroendocrine cancer cases identified among 453 cervical cancer patients between 2004 and 2021 at Akdeniz University Gynecological Oncology Outpatient Clinic. Kaplan–Meier survival analysis was used for progression-free survival (PFS) and overall survival (OS). Mathematical functions of mean, standard deviation, median, Min–Max values, and frequencies were used for descriptive statistics. The categorical data were expressed in numbers and percentages (%). Results Nine patients with neuroendocrine histological subtype were selected out of 453 patients diagnosed with cervical cancer (1.98%). The average overall survival time of the patients was 26 months. The 5-year survival rate was 53.3%, while the PFS was 62.5%. The most common subtype was small cell neuroendocrine cancer. Tumours were mostly locally advanced at the time of diagnosis. 3 patients' stage was 1b2, while 4 patients were 2b, 1 patient was 3c2r, and 1 patient was 4b. All tumours showed the immunohistochemical staining properties of neuroendocrine cancer. The main treatment modality applied to our patients was surgery + adjuvant CRT. The most used chemotherapeutic agents were cisplatin/carboplatin and etoposide. Recurrence was found in 3 cases, including 5 deaths. Conclusion Neuroendocrine tumour of the cervix is a rare subtype with a poor prognosis. Unfortunately, there is not yet a standard treatment protocol due to the limited number of comparative studies of surgery, chemotherapy, and radiotherapy based treatment schemes.
Collapse
|
7
|
Huang R, Gan Q, Cheng J. Prognostic Factors and Local Treatment Modalities of Small-Cell Carcinoma of the Cervix: An Analysis According to the International Federation of Gynecology and Obstetrics Stage. Cancer Manag Res 2020; 12:3445-3456. [PMID: 32523375 PMCID: PMC7236046 DOI: 10.2147/cmar.s247081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/23/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Small-cell carcinoma of the cervix (SCCC) is a rare type of cervical cancer. This study aimed to investigate the clinicopathological characteristics and survival as well as the optimal local treatment modalities for SCCC. Patients and Methods We retrospectively evaluated the data of patients diagnosed with SCCC between 1988 and 2015 in our institution - those included in the Surveillance, Epidemiology, and End Results (SEER) database and those in the Periodical Database. Kaplan-Meier method and Cox regression proportional hazard methods were used to evaluate overall survival (OS). A nomogram that could predict OS was constructed based on the Cox proportional hazard model. Results In total, 695 patients were included in this study. The 5-year overall survival in FIGO stage I-IIA and IIB-IV patients was 45.7% and 14.4%, respectively (P <0.01). Univariate and multivariate analyses showed that lymph node status (P <0.01) and cancer-directed surgery (P <0.01) were independent prognostic factors for FIGO I-IIA stage patients, and age (P <0.05), tumor size (P <0.01), chemotherapy (P <0.01) and radiation (P <0.01) were independent prognostic factors for FIGO stage IIB-IV patients. Conclusion Better prognosis was associated with negative lymph node status, no lymphatic vasculature, surgery, and early-stage patients. Furthermore, our data showed that the prognosis and treatment pattern varied depending on the FIGO stage, and that optimal treatment modalities included radical surgery for early-stage SCCC and chemoradiotherapy for advanced-stage SCCC. It is helpful to assess the individual prognosis of SCCC patients and choose personalized treatment modalities.
Collapse
Affiliation(s)
- Ru Huang
- Department of Obstetrics and Gynecology, The Shanghai East Hospital, Shanghai 200120, People's Republic of China
| | - Qiyu Gan
- Department of Obstetrics and Gynecology, The Shanghai East Hospital, Shanghai 200120, People's Republic of China
| | - Jingxin Cheng
- Department of Obstetrics and Gynecology, The Shanghai East Hospital, Shanghai 200120, People's Republic of China
| |
Collapse
|
8
|
Kim JH, Shim SH, Nam SH, Lee SW, Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT. Prognostic Factors and Impact of Minimally Invasive Surgery in Early-stage Neuroendocrine Carcinoma of the Cervix. J Minim Invasive Gynecol 2020; 27:1558-1565. [PMID: 32084588 DOI: 10.1016/j.jmig.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/26/2020] [Accepted: 02/11/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To investigate the prognostic factors and impact of minimally invasive surgery (MIS) in surgically treated early-stage high-grade (HG) neuroendocrine cervical carcinoma (NECC). DESIGN Retrospective cohort study. SETTING Asan Medical Center, Seoul, Korea. PATIENTS Patients with International Federation of Obstetrics and Gynecology (2009) stages IB1 to IIA HG NECC. INTERVENTIONS All patients underwent radical hysterectomy (RH) with a laparotomy or an MIS approach. MEASUREMENTS AND MAIN RESULTS Between 1993 and 2017, 47 patients with International Federation of Obstetrics and Gynecology stages IB1 to IIA1 HG NECC were initially treated with RH. Clinicopathologic variables of patients were retrospectively reviewed from electronic medical records. The median follow-up period was 28.2 months (interquartile range, 17.1-42). Stage IB1 disease was the most common (70.2%). Twenty-nine patients (61.7%) underwent RH by MIS. The overall survival (OS) and disease-free survival (DFS) rates were 63.8% and 38.3%, respectively. Lymph node metastasis and resection margin involvement were significant risk factors for DFS (hazard ratio [HR], 2.227; 95% confidence interval [CI], 1.018-4.871; p =.045 and HR, 6.494; 95% CI, 1.415-29.809; p =.016, respectively) and OS (HR, 3.236; 95% CI, 1.188-8.815; p =.022 and HR, 12.710; 95% CI, 1.128-143.152; p =.040, respectively). The Kaplan-Meier survival curves revealed no significant differences in OS and DFS between the laparotomy and MIS groups (50% vs 72.4% log-rank p =.196, 38.9% vs 37.9% p =.975). CONCLUSION Lymph node metastasis and resection margin involvement were poor prognostic factors of survival outcomes in initially surgically treated early-stage HG NECC. No difference was observed in the survival outcomes between the MIS and laparotomy approaches.
Collapse
Affiliation(s)
- Ju-Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Gyeonggi-do (Dr. Ju-Hyun Kim)
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Gwangjin-gu (Dr. Shim)
| | - So-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Shin-Wha Lee
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Dae-Yeon Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea..
| | - Dae-Shik Suh
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Jong-Hyeok Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Yong-Man Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| | - Young-Tak Kim
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-gu (Drs. Nam, Lee, Park, D. Y. Kim, Suh, Jong-Hyeok Kim, Y. M. Kim, and Y. T. Kim), Seoul, Korea
| |
Collapse
|
9
|
Li J, Ouyang Y, Tao Y, Wang L, Li M, Gao L, Cao X. Small cell carcinoma of the uterine cervix: a multi-institutional experience. Int J Gynecol Cancer 2019; 30:174-180. [PMID: 31792086 DOI: 10.1136/ijgc-2019-000612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Small cell carcinoma of the uterine cervix is associated with a poor prognosis with a median overall survival that is quite low. The aim of this study was to determine the clinico-pathologic characteristics that have an impact on survival in patients with small cell carcinoma of the uterine cervix. METHODS A total of 93 patients were involved in this retrospective study. Inclusion criteria were patients diagnosed with histopathologically confirmed small cell carcinoma of the uterine cervix and then later treated at three participating centers, between June 2001 and March 2015. Those without complete available follow-up records were excluded. The endpoints of this study were disease-free survival and overall survival. Kaplan-Meier and Cox regression methods were used for analyses. RESULTS There were statistical differences in overall survival between patients in early and in advanced stages by using the 2009 International Federation of Gynecology and Obstetrics (FIGO) clinical stage. There were 75 patients with FIGO stage I to IIA (56 patients stage I, 17 patients stage IIA, and two patients stage IB or IIA because of uncertainty as to whether the fornix was involved); and 18 patients with FIGO stage IIB and above (10 patients IIB stage, five patients stage III, and three patients stage IV). Among the 76 patients who had surgery, 73 (96%) had a radical hysterectomy with pelvic lymph node dissection and three (4%) patients had a simple hysterectomy without lymph node dissection. For early-stage patients, the 5 year disease-free survival rate was 52.7% compared with 32.4% in the advanced stage group (p=0.022). The disease-free survival for the early-stage group was 64.4% compared with 36.7% in the advanced-stage group (p=0.047). For factors affecting overall survival, age at diagnosis, tumor homology, tumor size, depth of stromal invasion, lymph node involvement, and treatment modality failed to reach significance in both univariate and multivariate analysis. CONCLUSION FIGO stage was a prognostic factor impacting survival-both overall survival and disease-free survival. Age at diagnosis, tumor histology (pure or mixed), tumor size, depth of stromal invasion, lymph node involvement, and treatment modality did not have an impact on overall survival.
Collapse
Affiliation(s)
- Junyun Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yi Ouyang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yalan Tao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Ligen Wang
- Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyi Li
- Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lei Gao
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinping Cao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| |
Collapse
|
10
|
Eto S, Kai K, Nasu K, Nishida M, Nishida H, Narahara H. Small cell carcinoma of the uterine cervix during pregnancy. Rare Tumors 2019; 11:2036361319866539. [PMID: 31413821 PMCID: PMC6676253 DOI: 10.1177/2036361319866539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/02/2019] [Indexed: 11/15/2022] Open
Abstract
Small cell carcinoma of the uterine cervix is a rare histological entity that has a poor prognosis. We report the case of a patient with small cell carcinoma of the uterine cervix who underwent a radical hysterectomy during pregnancy. A 33-year-old Japanese woman with genital bleeding was referred at 15 weeks' gestation. A speculum exam revealed a 5.4-cm-dia. mass in the cervix, and a cervical biopsy revealed small cell carcinoma of the uterine cervix. Imaging studies demonstrated a tumor confined to the cervix, swelling of intra-pelvic lymph nodes, and no distant spread of the tumor. She was diagnosed as having small cell carcinoma of the uterine cervix, stage IB2, and underwent a radical hysterectomy with pelvic lymphadenectomy. She refused any adjuvant therapies, had a systemic relapse 4 months after surgery, and died of the disease 5 months after surgery. Early-stage small cell carcinoma of the uterine cervix should be treated with a definitive therapy soon after diagnosis whether the patient is pregnant or not. Saving the mother's life should be the top priority.
Collapse
Affiliation(s)
- Satoshi Eto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Kentaro Kai
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.,Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital, Oita, Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.,Division of Obstetrics and Gynecology, Support System for Community Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Masakazu Nishida
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan
| |
Collapse
|
11
|
Weil EL, Richards LW, Salonen BR. 64-Year-Old Woman With General Malaise and Hypercalcemia. Mayo Clin Proc 2018; 93:1144-1148. [PMID: 29804727 DOI: 10.1016/j.mayocp.2017.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Erika L Weil
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Lukas W Richards
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Bradley R Salonen
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
12
|
Hou WH, Schultheiss TE, Wong JY, Wakabayashi MT, Chen YJ. Surgery Versus Radiation Treatment for High-Grade Neuroendocrine Cancer of Uterine Cervix: A Surveillance Epidemiology and End Results Database Analysis. Int J Gynecol Cancer 2018; 28:188-93. [PMID: 29206662 DOI: 10.1097/IGC.0000000000001143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess treatment and other factors impacting survival in cervical high-grade neuroendocrine carcinoma (HGNEC). METHODS/MATERIALS We identified patients with cervical HGNECs diagnosed during 1988 to 2012 in the Surveillance Epidemiology and End Results database. We determined overall survival by International Federation of Gynecology and Obstetrics stages and by local treatment modalities, that is, radical surgery versus external beam radiation treatment (EBRT) plus brachytherapy using Kaplan-Meier analysis with log-rank test. We also determined factors of age, stage, and treatment modality impacting survival using proportional hazard analysis. RESULTS We identified 832 cases of cervical HGNECs in the database. After excluding cases with incomplete stage data, the International Federation of Gynecology and Obstetrics stages I to IV distributions were 196 (28.0%), 69 (9.9%), 175 (25.0%), and 260 patients (37.1%), respectively. Radical surgery and primary radiotherapy yielded similar 5-year overall survival for stages I (61% vs 53%, P = 0.27), II (48% vs 28%, P = 0.308), and III (33% vs 28%, P = 0.408) patients. External beam radiation treatment plus brachytherapy did not yield superior survival than EBRT alone in stage I (48% vs 49%, P = 0.799), II (37% vs 20%, P = 0.112), or III (25% vs 32%, P = 0.636) patients. Age (P = 0.004) and stage (stage II: hazard ratio [HR], 1.78, P = 0.013; stage III: HR, 2.42; P < 0.001) were independent factors impacting survival but not local treatment modality (EBRT: HR, 1.30, P = 0.17; EBRT plus brachytherapy: HR, 1.16; P = 0.417). CONCLUSIONS Patients with cervical HGNECs had poor prognosis. Primary treatment by radical surgery or external beam radiotherapy with or without brachytherapy yielded equally poor survival.
Collapse
|
13
|
Ishikawa M, Kasamatsu T, Tsuda H, Fukunaga M, Sakamoto A, Kaku T, Nakanishi T, Hasumi Y, Iwata T, Baba T, Nogawa T, Kudaka W, Kaneda H, Ono S, Saito F, Taniguchi Y, Okada S, Mizuno M, Onda T, Yaegashi N. Prognostic factors and optimal therapy for stages I-II neuroendocrine carcinomas of the uterine cervix: A multi-center retrospective study. Gynecol Oncol 2018; 148:139-46. [PMID: 29113721 DOI: 10.1016/j.ygyno.2017.10.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/14/2017] [Accepted: 10/24/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE We aimed to determine appropriate treatment guidelines for patients with stages I-II high-grade neuroendocrine carcinomas (HGNEC) of the uterine cervix in a multicenter retrospective study. PATIENTS AND METHODS We reviewed the clinicopathological features and prognoses of 93 patients with HGNEC of International Federation of Gynecology and Obstetrics (FIGO) stages I and II. All patients were diagnosed with HGNEC by central pathological review. RESULTS The median overall survival (OS) and disease-free survival (DFS) were 111.3months and 47.4months, respectively. Eighty-eight patients underwent radical surgery, and five had definitive radiotherapy. The hazard ratio (HR) for death after definitive radiotherapy to death after radical surgery was 4.74 (95% confidence interval [CI], 1.01-15.90). Of the surgery group, 18 received neoadjuvant chemotherapy. Pathological prognostic factors and optimal adjuvant therapies were evaluated for the 70 patients. Forty-one patients received adjuvant chemotherapy with etoposide-platinum (EP) or irinotecan-platinum (CPT-P). Multivariate analyses identified the invasion of lymphovascular spaces as a significant prognostic factor for both OS and DFS. Pelvic lymph node metastasis was also a prognostic factor for DFS. Adjuvant chemotherapy with an EP or CPT-P regimen appeared to improve DFS (HR=0.27, 95% CI, 0.10-0.69). A trend toward improved OS was also observed, but was not statistically significant (HR=0.39, 95% CI, 0.15-1.01). CONCLUSION Radical surgery followed by adjuvant chemotherapy with an EP or CPT-P regimen was optimal treatment for stages I and II HGNEC of the uterine cervix.
Collapse
|
14
|
Pei X, Xiang L, Ye S, He T, Cheng Y, Yang W, Wu X, Yang H. Cycles of cisplatin and etoposide affect treatment outcomes in patients with FIGO stage I-II small cell neuroendocrine carcinoma of the cervix. Gynecol Oncol 2017; 147:589-96. [PMID: 28954697 DOI: 10.1016/j.ygyno.2017.09.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/17/2017] [Accepted: 09/19/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study sought to explore the outcomes and prognostic factors of patients with small cell neuroendocrine carcinoma of the cervix (SCNEC) and to determine the effects of adjuvant treatment on survival in patients with FIGO stage I-II SCNEC after radical surgery. METHODS A single-institution retrospective analysis was performed in 92 patients who underwent radical surgery for SCNEC. All clinicopathological variables and treatment strategies were reviewed. Kaplan-Meier and Cox regression methods were used for survival analyses. RESULTS During a median follow-up period of 38months (23.6-52.4), 43 (46.7%) patients experienced disease recurrence, and distant metastases were documented in 35 (81.4%) patients. The 3-year recurrence-free survival (RFS) for the entire group was 50.1%. The median RFS was 39months. The multivariate analysis confirmed that lymph node metastasis, positive parametrial extension and cycles of etoposide plus platinum (EP) were independent prognostic factors for disease recurrence. Adjuvant chemotherapy for at least 5cycles of EP (EP 5+, n=39) was associated with improved 5-year RFS compared with other treatments (n=46) (67.6% vs. 20.9%, p<0.001). Additional radiotherapy or concurrent chemoradiation failed to validate further improved RFS in patients with EP 5+, and this finding was consistent in the subset of patients with high-risk factors (positive lymph nodes or positive parametrium). CONCLUSIONS Half of stage I-II SCNEC patients experienced disease failure within 3years, and distant metastasis was an outstanding issue. EP regimen for at least 5cycles improved long-term RFS after radical surgery. Additional radiation might be unnecessary, even in patients with high-risk factors.
Collapse
|
15
|
Stecklein SR, Jhingran A, Burzawa J, Ramalingam P, Klopp AH, Eifel PJ, Frumovitz M. Patterns of recurrence and survival in neuroendocrine cervical cancer. Gynecol Oncol 2016; 143:552-557. [PMID: 27645621 DOI: 10.1016/j.ygyno.2016.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze patterns of recurrence and survival and identify prognostic factors in women with neuroendocrine cervical cancer (NECC). METHODS We reviewed patients with International Federation of Gynecology and Obstetrics stage I-IVA NECC who were enrolled in the Neuroendocrine Cervical Tumor Registry and treated with curative intent. Event-free survival (EFS) and overall survival (OS) according to disease and treatment characteristics were analyzed using the Kaplan-Meier method. RESULTS Among 40 patients with NECC, 25 (62%) had small cell NECC, eight (20%) had large cell NECC, and seven (18%) had unspecified neuroendocrine histology. With a median follow-up of 21.5months, 32 patients (80%) experienced progression, and 28 (70%) died. For all patients, the 5-year EFS rate was 20%, and the 5-year OS rate was 27%. Patients with large cell NECC had significantly better median EFS (median not reached vs. 10.0months, p=0.02) and showed a trend toward better median OS (153months vs. 21months, p=0.08) than patients with other histologic types. In patients with early-stage clinically node-negative disease, chemoradiation was associated with significantly better median EFS than surgery (median not reached vs. 18.0months, p=0.04). CONCLUSIONS Patients with large cell NECC have better outcomes than patients with other subtypes of NECC. In early-stage node-negative NECC, chemoradiation yields better EFS than surgery. Most patients with NECC, even those with no evidence of nodal disease at diagnosis, rapidly develop widespread hematogenous metastases and die of their disease.
Collapse
Affiliation(s)
- Shane R Stecklein
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer Burzawa
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael Frumovitz
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| |
Collapse
|
16
|
Satoh T, Takei Y, Treilleux I, Devouassoux-Shisheboran M, Ledermann J, Viswanathan AN, Mahner S, Provencher DM, Mileshkin L, Åvall-Lundqvist E, Pautier P, Reed NS, Fujiwara K. Gynecologic Cancer InterGroup (GCIG) consensus review for small cell carcinoma of the cervix. Int J Gynecol Cancer 2014; 24:S102-8. [PMID: 25341572 DOI: 10.1097/IGC.0000000000000262] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Small cell carcinoma of the cervix (SCCC) is a rare histological entity of uterine cervical cancer. Compared with other common histological types, squamous cell carcinoma or adenocarcinoma, the outcome of SCCC is poor because of the high incidence of nodal or distant metastasis even with early stage. In this review, current consensus of epidemiology, pathology, and initial treatment for SCCC will be discussed.
Collapse
|
17
|
Chen TC, Huang HJ, Wang TY, Yang LY, Chen CH, Cheng YM, Liou WH, Hsu ST, Wen KC, Ou YC, Hung YC, Lai HC, Ho CM, Chang TC. Primary surgery versus primary radiation therapy for FIGO stages I-II small cell carcinoma of the uterine cervix: A retrospective Taiwanese Gynecologic Oncology Group study. Gynecol Oncol 2015; 137:468-73. [PMID: 25797082 DOI: 10.1016/j.ygyno.2015.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/12/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the role of surgery, radiation therapy and chemotherapy in the management of small cell carcinoma of the uterine cervix (SCCC) through a retrospective study of Taiwanese Gynecologic Oncology Group. METHODS We reviewed the medical records and histological files of 144 patients with FIGO stages IA-IIB SCCC treated in 11 main hospitals in Taiwan from 1987 to 2009. RESULTS There were 110 patients receiving primary surgery and 34 primary radiation therapy. Most patients in each group also received chemotherapy as part of primary treatment. A lower loco-regional failure rate was observed in patients who received primary radiation therapy than in those who had primary surgery (6% vs. 27%; P=0.009). The 5-year overall survival (OS) was 89% for 13 surgically treated patients with cervical tumor ≤2cm and no lymphovascular space involvement (LVSI) in whom recurrence was noted in 2 of 4 patients without receiving adjuvant chemotherapy and none in the 9 patients who had chemotherapy. Excluding these 13 patients, primary radiation therapy with at least 5cycles of platinum-based chemotherapy (n=14, including 12 stages IB2-IIB) resulted in a 5-year OS of 78%, better than that of 46% by primary surgery (n=97, including 40 stages IB2-IIB) (P=0.046). CONCLUSIONS None of the 9 patients with cervical tumor ≤2cm and no LVSI showed disease recurrence after primary surgery and adjuvant chemotherapy. For most patients with stages I-II, primary radiation therapy with aggressive chemotherapy was associated with better survival than surgery.
Collapse
Affiliation(s)
- Tze-Chien Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Graduate Institute of Medical Sciences, Taipei Medical University, Taiwan; General Education Center, Tatung University, Taipei, Taiwan
| | - Huei-Jean Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University Medical College, Taoyuan, Taiwan
| | - Tao-Yeuan Wang
- Department of Pathology, Mackay Medical College and Mackay Memorial Hospital, New Taipei City, Taiwan; Mackay Medicine, Nursing and Management College, New Taipei City, Taiwan
| | - Lan-Yan Yang
- Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chi-Hau Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Min Cheng
- Department of Obstetrics Gynecology, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Hsiung Liou
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Chang Wen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Che Ou
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Yao-Ching Hung
- Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Cheng Lai
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Ming Ho
- Gynecologic Cancer Center, Cathay General Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Hsinchuang, New Taipei City, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan; Chang Gung University Medical College, Taoyuan, Taiwan.
| |
Collapse
|
18
|
Intaraphet S, Kasatpibal N, Siriaunkgul S, Chandacham A, Sukpan K, Patumanond J. Prognostic factors for small cell neuroendocrine carcinoma of the uterine cervix: an institutional experience. Int J Gynecol Cancer 2014; 24:272-9. [PMID: 24401981 DOI: 10.1097/IGC.0000000000000059] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to determine the clinicopathologic characteristics that affected the survival in patients with small cell neuroendocrine carcinoma of the uterine cervix (SNEC). MATERIALS AND METHODS All patients with SNEC treated at Chiang Mai University Hospital between January 1995 and October 2011 were retrospectively reviewed with histologic confirmation of SNEC diagnosis. The prognostic predictors for survival were assessed using competing risk regression analysis concerning the probabilities of competing events. RESULTS One hundred thirty histologically confirmed patients with SNEC met the study criteria. The median overall survival and median cancer-specific survival (CSS) for entire group were 47.8 and 58.1 months, respectively. Five-year CSS for patients with early-stage disease was 62.6% and for patients with advanced-stage disease was 18.1% (P < 0.001). Among the patients with surgically treated early-stage disease, those with adjuvant chemotherapy had a better 5-year survival rate than those with surgery alone, those with adjuvant radiotherapy, and those with adjuvant chemoradiation therapy (P = 0.041). In multivariable analyses, decreased survival in patients with early-stage disease was associated with age older than 60 years at diagnosis (hazards ratio [HR], 4.9; P = 0.007) and deep stromal invasion (HR, 2.9; P = 0.011). Among the patients with advanced-stage disease, decreased survival was associated with age at diagnosis (older than 60 years: HR, 9.9; P < 0.001 and younger than 45 years: HR, 3.4; P = 0.035) and International Federation of Gynecology and Obstetrics stage IV (HR, 7.4; P = 0.024). CONCLUSIONS International Federation of Gynecology and Obstetrics stage, age at diagnosis, and deep stromal invasion were important prognostic factors for CSS in patients with SNEC. Adjuvant chemotherapy may provide survival benefits in surgically treated patients with early-stage SNEC.
Collapse
|
19
|
Intaraphet S, Kasatpibal N, Søgaard M, Khunamornpong S, Patumanond J, Chandacham A, Chitapanarux I, Siriaunkgul S. Histological type-specific prognostic factors of cervical small cell neuroendocrine carcinoma, adenocarcinoma, and squamous cell carcinoma. Onco Targets Ther 2014; 7:1205-14. [PMID: 25061322 PMCID: PMC4085311 DOI: 10.2147/ott.s64714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to determine the prognostic impact of clinical and pathological factors on survival among patients with small cell neuroendocrine carcinoma (SNEC), adenocarcinoma (ADC), and squamous cell carcinoma (SCC). Methods Eligible participants were all patients with histologically confirmed cervical cancer treated at Chiang Mai University Hospital between 1995 and 2011. We included all patients with SNEC and randomly enrolled patients with ADC and SCC. We used competing-risk regression analysis to examine the risk of cancer-related death by histological type. Results We included 130 (6.2%) women with SNEC, 346 (16.4%) with ADC, and 1,632 (77.4%) with SCC. Age >60 years (hazard ratio [HR] 4.9, 95% confidence interval [CI] 2.0–12.0) and lymph node involvement (HR 3.0, 95% CI 1.2–7.4) were prognostic factors among surgically-treated patients with SNEC. Deeper stromal invasion (HR 3.6, 95% CI 1.6–8.3) was a prognostic factor in patients with SCC. In patients with advanced SNEC, age >60 years had a strong prognostic impact (HR 2.6, 95% CI 1.0–6.5) while the International Federation of Gynecology and Obstetrics stages III and IV were prognostic factors for patients with advanced stage ADC (HR 2.9, 95% CI 2.0–4.4 and HR 4.5, 95% CI 2.6–7.9, respectively) and SCC (HR 1.7, 95% CI 1.4–2.0 and HR 3.7, 95% CI 2.8–4.9, respectively) compared with the International Federation of Gynecology and Obstetrics stage IIB. Conclusion Clinical and pathological prognostic factors in cervical cancer differed according to histological type. Taking the important prognostic factors for each histological type into consideration may be beneficial for tailored treatment and follow-up planning.
Collapse
Affiliation(s)
- Suthida Intaraphet
- Boromarajonani College of Nursing, KhonKaen, Thailand and Clinical Epidemiology Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Surapan Khunamornpong
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Clinical Research Center, Faculty of Medicine, Thammasat University, PathumThani, Thailand
| | - Anchalee Chandacham
- Department of Gynecology and Obstetrics, Nakornping Hospital, Chiang Mai, Thailand
| | - Imjai Chitapanarux
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sumalee Siriaunkgul
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
20
|
McCann GA, Boutsicaris CE, Preston MM, Backes FJ, Eisenhauer EL, Fowler JM, Cohn DE, Copeland LJ, Salani R, O'Malley DM. Neuroendocrine carcinoma of the uterine cervix: The role of multimodality therapy in early-stage disease. Gynecol Oncol 2013; 129:135-9. [DOI: 10.1016/j.ygyno.2013.01.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 01/02/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
|