Comparison of Clinical Manifestations and Survival Outcomes between Neuroendocrine Tumor and Squamous Cell Carcinoma of the Uterine Cervix: Results from a Tertiary Center in Southern Thailand
Kanchid Sodsanrat MD*, Nungrutai Saeaib MD*, Tippawan Liabsuetrakul MD, PhD*,**
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand ** Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Objective : To study the clinical manifestations and survival outcomes of neuroendocrine tumor of the uterine cervix (NTUC)
and compare them with those of squamous cell carcinoma (SCCA)
Material and Method: A case-control study was conducted. In the study group, we included patients whose tumors were
described in the original pathology reports as NTUC. For the control group, we calculated the sample size based on a
formula according to survival rate. The ratio of cases to controls was 1:4. Patients with a diagnosis of SCCA of the uterine
cervix and treated between January 2003 and December 2011 in Songklanagarind Hospital were included in the control
group according to stage and year of NTUC diagnosis. The patients’ characteristics, method of treatment, treatment outcomes,
and survival of the two groups were compared. The prognostic factors among patients with NTUC were analyzed using the
Cox regression.
Results : Of the 2,835 cervical carcinoma cases studied, 44 (1.6%) were NTUC. NTUC patients had a lower mean age at
diagnosis, received more multimodality treatments, had a lower complete response rate, a higher recurrence rate, and more
distant metastasis than their SCCA counterparts. A significantly lower 2-year and 5-year survival was detected in NTUC
compared with SCCA (62% and 52% vs. 97% and 85%, respectively, p<0.01). In the univariate analysis, the number of
sexual partners, stage of disease, surgery treatment, status of response, and site of recurrence predicted a poorer overall
survival in NTUC. However, these factors were not found to be statistically significant prognostic factors on multivariate
analysis.
Conclusion : A poorer treatment outcome and prognosis were found in NTUC compared with SCCA. Moreover, a poorer
prognosis was observed in NTUC patients with an advanced-stage disease, non-surgery treatment, progressive disease, and
distant metastasis recurrence than in those with SCCA patients. Multimodality treatments should be considered in NTUC
to improve survival. Additionally, close monitoring may be necessary in this group of patients.
Keywords : Neuroendocrine tumor, Cervix, Clinical manifestation, Survival
