Valenza Carmine, Spada Francesca, Multinu Francesco, Benini Lavinia, Borghesani Michele, Algeri Laura, Rubino Manila, Pisa Eleonora, Gervaso Lorenzo, Cella Chiara Alessandra, Carinelli Silvestro, Bruni Simone, Schivardi Gabriella, Curigliano Giuseppe, Zanagnolo Vanna, Aletti Giovanni, Colombo Nicoletta, Fazio Nicola
Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Via Ripamonti, Milan, Italy.
Department of Oncology and Hemato-Oncology (DIPO), University of Milan, Milan, Italy.
Endocr Relat Cancer. 2023 Aug 14;30(10). doi: 10.1530/ERC-23-0112. Print 2023 Oct 1.
Non-metastatic neuroendocrine carcinoma of the cervix (NECC) is a rare and aggressive disease. Lacking prospective studies, the optimal multimodal treatment approach has not yet been clearly defined. This study aims to assess the clinical outcomes of patients with non-metastatic NECC treated with surgery and (neo)adjuvant chemotherapy, according to pathologic prognostic factors and multimodal treatments received. We retrospectively examined data from patients with non-metastatic NECC candidate to receive surgery and (neo)adjuvant chemotherapy and discussed at the European Institute of Oncology's Multidisciplinary Neuroendocrine Tumor Board, between January 2003 and December 2021. Primary endpoints were event-free survival and overall survival. A total of 27 consecutive patients were evaluated, 15 with early stage NECC and 12 with a locally advanced NECC. Eight patients received neoadjuvant and 19 adjuvant platinum-based chemotherapy; 14 received adjuvant pelvic radiotherapy, half with external-beam radiation therapy alone, and half combined with brachytherapy. No patients progressed or relapsed during (neo)adjuvant chemotherapy. The median event-free survival was 21.1 months and the median overall survival was 33.0 months. Pathological FIGO stage ≥ IIB, adjuvant external-beam radiation therapy with or without brachytherapy emerged as significant and independent prognostic factors for event-free survival. Brachytherapy was also prognostic for overall survival. Non-metastatic NECC requires a multimodal approach, mainly weighted on the FIGO stage. The addition of brachytherapy should be considered, especially in patients with locally advanced disease. Because of the scarcity of robust clinical data, treatment strategy should be discussed in multidisciplinary board, taking into account patient.
宫颈非转移性神经内分泌癌（NECC）是一种罕见且侵袭性强的疾病。由于缺乏前瞻性研究，最佳的多模式治疗方法尚未明确界定。本研究旨在根据病理预后因素和接受的多模式治疗，评估接受手术及（新）辅助化疗的非转移性NECC患者的临床结局。我们回顾性分析了2003年1月至2021年12月期间在欧洲肿瘤研究所多学科神经内分泌肿瘤委员会讨论的、有接受手术及（新）辅助化疗指征的非转移性NECC患者的数据。主要终点为无事件生存期和总生存期。共评估了27例连续患者，其中15例为早期NECC，12例为局部晚期NECC。8例患者接受了新辅助化疗，19例接受了辅助铂类化疗；14例接受了辅助盆腔放疗，其中一半仅接受外照射放疗，另一半联合近距离放疗。在（新）辅助化疗期间无患者进展或复发。中位无事件生存期为21.1个月，中位总生存期为33.0个月。病理国际妇产科联盟（FIGO）分期≥IIB、辅助外照射放疗联合或不联合近距离放疗是无事件生存期的显著且独立的预后因素。近距离放疗对总生存期也有预后价值。非转移性NECC需要多模式治疗方法，主要根据FIGO分期来权衡。应考虑增加近距离放疗，尤其是局部晚期疾病患者。由于可靠临床数据稀缺，治疗策略应在多学科委员会中讨论，并考虑患者情况。
