Retrospective Analysis of Clinicopathological Features and Prognosis of Gynecological Small-Cell Carcinoma

Abstract

Purpose

Although rare, small-cell neuroendocrine carcinoma of the gynecologic tract (SCNCGT) is associated with poor prognosis. We analyzed the clinical characteristics, pathological features, treatment strategies, and prognosis in patients with SCNCGT.

Patients and Methods

We performed a retrospective data analysis of 34 patients with SCNCGT diagnosed and treated at our hospital between 2006 and 2018. Medical records were reviewed for pathological features, treatment methods, and outcomes of this disease.

Results

We included 34 patients who had small-cell neuroendocrine carcinoma of the endometrium (SCNCE; 7), ovary (SCNCO; 7), and cervix (SCNCC; 20). All patients with SCNCE underwent comprehensive surgery and six received postoperative chemotherapy. All patients with SCNCO received chemotherapy after surgery; six underwent comprehensive surgery and one underwent treatment only in the pelvic cavity. Sixteen patients with SCNCC underwent radical surgery and received chemotherapy, two of whom received simultaneous radiotherapy. The remaining four patients with SCNCC underwent comprehensive chemotherapy and radiation therapy. Among the 34 patients, 11 had vascular metastases, 15 had lymph node metastases, and seven exhibited positive margins. The median overall survival time among all patients was 23.18 months (range: 3–66 months). Death occurred in 18 cases (52.94%). Recurrence was observed in 13 cases (38.24%). The average time to recurrence was 15.78 months following treatment (range: 2–30 months). All 34 patients were evaluated for neuroendocrine markers. The immunohistochemical positive rates of synaptophysin, CD56, and chromogranin A were 73.5%, 64.7%, and 55.9%, respectively.

Conclusion

The rates of metastasis and recurrence are high, and prognosis remains poor, even among patients with early-stage SCNCGT. Our data may aid in the development of reference standards for diagnosis and treatment.

Keywords:

• comprehensive treatment
• gynecologic tract
• malignant tumor
• metastasis
• small-cell carcinoma

Abbreviations

AD, adnexectomy; BEP, bleomycin + etoposide + cisplatin; CK, creatine kinase; CS, cytoreductive surgery; DFS, disease-free survival; EFH, extra-fascial hysterectomy; EP, etoposide + cisplatin; FIGO, Federation of Gynecology and Obstetrics; LN, pelvic lymph node dissection; NSE, neuron-specific enolase; OS, overall survival; Pa-LN, Para-aortic lymph node resection; PFS, progression-free survival; RH, radical hysterectomy; RTC, radiotherapy and chemotherapy; SCC, Squamous cell carcinoma; SCNCC, small-cell neuroendocrine carcinoma of the cervix; SCNCE, small-cell neuroendocrine carcinoma of the endometrium; SCNCGT, small-cell neuroendocrine carcinoma of the gynecologic tract; SCNCO, small-cell neuroendocrine carcinoma of the ovary; SSAs, somatostatin analogues; TC, paclitaxel/carboplatin; TP, docetaxel + cisplatin.

Ethics Approval and Informed Consent

This retrospective study was approved by the Ethics Committee of ShengJing Hospital of China Medical University. All patients provided informed written consent. This study was conducted in accordance with the Declaration of Helsinki.

Consent for Publication

All listed authors have actively participated in the study and have read and approved the submitted manuscript.

Disclosure

The authors report no conflicts of interest in this work.