Neuroendocrine cervical carcinoma: A diagnostic and therapeutic challenge

Objective. The aim of this study was to analyze diagnostic criteria, respon se to chemotherapy, rate and site of relapse, and overall survival (OS) in neuroendocrine cervical carcinoma. Methods. Twenty patients were included. Stage was Ia, in 1 case, Ib(1) in 4 , Ib(2) in 4, II in 5, IIIb in 2, IVa in 2, and IVb in 2. Patients with sta ge Tb, or greater received neoadjuvant chemotherapy (NCH). Eighteen patient s were operated on. Immunohistochemistry was performed on the surgical spec imens. Statistical analysis included the Kaplan-Meier method and the chi (2 ) and log-rank tests. Results. The response to NCH was < 50% in 2/13 cases (15.3%), > 50% in 9/13 (69.4%), and complete in 2/13 (15.3%). Cytokeratin was positive in 17/18 c ases, neuron-specific enolase in 15/18, chromogranin in 9/18, and synaptoph ysin in 8/18. Tumor was pure in 12 cases. Two cases had simultaneous ovaria n carcinoma. Positive nodes were observed in 9/20 pts (45%). Tumors <4 cm h ad no recurrences. Pure tumors >4 cm had distant relapses (6/11). Mixed tum ors >4 cm had 2/6 pelvic and 3/6 lung metastases. OS was 39%. When the init ial tumor volume was <4 cm OS was 76%, and it was 18% for tumors >4 cm (P < 0.05). OS was 58% when the residual tumor after NCH was <2 cm and 21% when it was >2 cm (P < 0.05). When the tumor was pure OS was 54% and 19% when i t was mixed (P < 0.05). OS was 72% among pts with negative nodes and 11% fo r those with positive nodes (P <less than> 0.01). Conclusions. (1) Stage IV was frequent (20%); (2) Response to NCH was high; (3) The pattern of relapse differs for mixed tumors; (4) For tumors <4 cm outcome is similar to that of squamous carcinoma. (C) 2001 Academic Press.