Mitsuya Ishikawa1, Takahiro Kasamatsu2, Hitoshi Tsuda3, Masaharu Fukunaga4, Atsuhiko Sakamoto5, Tsunehisa Kaku6, Tatsuya Kato7, Kazuaki Takahashi8, Kazuya Ariyoshi9, Kayo Suzuki10, Takahide Arimoto11, Yoshinari Matsumoto12, Hidekatsu Nakai13, Takafumi Inoue14, Masatoshi Yokoyama15, Takayo Kawabata16, Shoji Kodama17, Tsutomu Miyamoto18, Masashi Takano19, Nobuo Yaegashi20. 1. Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. Electronic address: miishika@ncc.go.jp. 2. Department of Gynecology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. 3. Department of Basic Pathology, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan. 4. Department of Pathology, Shin-yurigaoka General Hospital, 255 Furusawa, Asao-ku, Kawasaki City, Kanagawa, 215-0026, Japan. 5. Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, 4-30-1 Chuou, Ota-ku, Tokyo, 143-8527, Japan. 6. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan. 7. Department of Obstetrics and Gynecology, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo City, Hokkaido, 060-8648, Japan. 8. Department of Obstetrics and Gynecology, The Jikei University School of Medicine, 3-19-18 Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan. 9. Gynecology Service, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Nodame, Minami-ku, Fukuoka City, Fukuoka, 811-1395, Japan. 10. Department of Obstetrics and Gynecology, The Jikei University Kashiwa Hospital, 163-1 Kashiwa-Shita, Kashiwa City, Chiba, 277-8567, Japan. 11. Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 12. Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, 1-5-7, Asahi-machi, Abeno-ku, Osaka City, Osaka, 545-8586, Japan. 13. Department of Obstetrics and Gynecology, Kindai University, Faculty of Medicine, 377-2 Ohnohigashi, Osaka-Sayama City, Osaka, 589-8511, Japan. 14. Department of Obstetrics and Gynecology, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, Fukuoka, 812-8582, Japan. 15. Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan. 16. Department of Obstetrics and Gynecology, Kagoshima City Hospital, 37-1 Uearata Chou, Kagoshima City, Kagoshima 890-8760, Japan. 17. Division of Gynecology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-machi, Chuou-ku, Niigata City, Niigata, 951-8566, Japan. 18. Department of Obstetrics and Gynecology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano 390-8621, Japan. 19. Department of Obstetrics and Gynecology, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan. 20. Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai City, Miyagi, 980-8574, Japan.
Abstract
OBJECTIVE: To analyze the clinical behavior of neuroendocrine tumors (NETs) of the uterine cervix, we conducted a multicenter, retrospective study of 193 patients. METHODS: We evaluated the prognosis of NETs according to the new International Federation of Gynecology and Obstetrics (FIGO) staging system, compared the clinical response to different chemotherapy regimens, and compared different histological subtypes of NETS. RESULTS: Diagnoses of the subjects were atypical carcinoid tumor (ACT, n = 37), small cell neuroendocrine carcinoma (SCNEC, n = 126), large cell neuroendocrine carcinoma (LCNEC, n = 22), and NET, not elsewhere classified (n = 8), according to central pathological review. According to FIGO 2018, 69, 17, 74, and 33 patients were at stage I, II, III, or IV, respectively. Five-year survival was 64.5%, 50.1%, 30.2%, and 3.4% for patients at stage I, II, III and IV. About 40% of patients with stage IIIC1 survived >5 years. On multivariate analyses, locally-advanced disease, para-aortic node metastasis, distant metastasis, and <4 cycles of chemotherapy were associated with poor survival. Histological subtype and pelvic node metastasis had no prognostic significance. Response rates to etoposide-platinum (EP) or irinotecan-platinum (CPT-P) regimens were 43.8% (28/64), but only 12.9% to a taxane-platinum (TC) regimen (4/31). The response rate for ACT was 8.7% (2/23), significantly less than the 36.6% for high-grade neuroendocrine carcinomas (HGNEC: both SCNEC and LCNEC, 41/111). CONCLUSIONS: Locally-advanced, extra-pelvic disease and insufficient chemotherapy were independent prognostic factors for cervical NET. HGNEC showed good responses to EP or CPT-P but not TC. Chemotherapy was less effective for ACT, which had a prognosis identical to HGNEC.
OBJECTIVE: To analyze the clinical behavior of neuroendocrine tumors (NETs) of the uterine cervix, we conducted a multicenter, retrospective study of 193 patients. METHODS: We evaluated the prognosis of NETs according to the new International Federation of Gynecology and Obstetrics (FIGO) staging system, compared the clinical response to different chemotherapy regimens, and compared different histological subtypes of NETS. RESULTS: Diagnoses of the subjects were atypical carcinoid tumor (ACT, n = 37), small cell neuroendocrine carcinoma (SCNEC, n = 126), large cell neuroendocrine carcinoma (LCNEC, n = 22), and NET, not elsewhere classified (n = 8), according to central pathological review. According to FIGO 2018, 69, 17, 74, and 33 patients were at stage I, II, III, or IV, respectively. Five-year survival was 64.5%, 50.1%, 30.2%, and 3.4% for patients at stage I, II, III and IV. About 40% of patients with stage IIIC1 survived >5 years. On multivariate analyses, locally-advanced disease, para-aortic node metastasis, distant metastasis, and <4 cycles of chemotherapy were associated with poor survival. Histological subtype and pelvic node metastasis had no prognostic significance. Response rates to etoposide-platinum (EP) or irinotecan-platinum (CPT-P) regimens were 43.8% (28/64), but only 12.9% to a taxane-platinum (TC) regimen (4/31). The response rate for ACT was 8.7% (2/23), significantly less than the 36.6% for high-grade neuroendocrine carcinomas (HGNEC: both SCNEC and LCNEC, 41/111). CONCLUSIONS: Locally-advanced, extra-pelvic disease and insufficient chemotherapy were independent prognostic factors for cervical NET. HGNEC showed good responses to EP or CPT-P but not TC. Chemotherapy was less effective for ACT, which had a prognosis identical to HGNEC.
Authors: Sushmita Gordhandas; Brooke A Schlappe; Qin Zhou; Alexia Iasonos; Mario M Leitao; Kay J Park; Louise de Brot; Kaled M Alektiar; Paul J Sabbatini; Carol A Aghajanian; Claire Friedman; Oliver Zivanovic; Roisin E O'Cearbhaill Journal: Gynecol Oncol Rep Date: 2022-08-04