Neuroendocrine carcinoma of the cervix: The value of postoperative radiation in early-stage disease

Краткое изложение: Objective: The current treatment for early-stage neuroendocrine carcinoma of the cervix (NECC) mainly relies on radical hysterectomy and chemotherapy. The routine use of postoperative radiation is still in controversial. We want to evaluate the value of postoperative radiation in early-stage NECC. 
Methods: A retrospective cohort study. Early-stage NECC patients from 2006 to 2022 in Peking Union Medical College Hospital were included. Depending on whether the patients received radiation therapy after surgery, they were divided into Postoperative non-radiation group (Group A) and Postoperative radiation group (Group B). We use Kaplan-Meier method to analyze the progression-free survival (PFS), overall survival (OS), recurrence and OS rate. 
Results: Sixty-six cases were included, 32 (48.5%) in Group A and 34 (51.5%) in Group B. After 35 (range 12-116) months follow-up, 26 (39.4%) experienced recurrence. Compared with Group A, Group B had lower pelvic recurrence rate (12.5% vs 2.9%, p = 0.142), slightly higher distant recurrence rate (28.1% vs 44.1%, p = 0.177), and similar mortality rate (29.4% vs 31.3%, p = 0.871). Cervical stromal invasion ≥1/2 was more common in Group B (28.0% vs 63.0%, p = 0.012). Postoperative radiation in patients with cervical stromal invasion ≥1/2 showed an extended trend in PFS (33.9 months vs 47.9 months) and OS (40.7 months vs 70.0 months) but without statistical difference (p = 0.963, p = 0.636). Lymph-vascular space invasion (LVSI) is a high-risk factor for tumor recurrence (HR 9.13, p = 0.005), but radiation after surgery did not improve the PFS (51.5 months vs 48.8 months, p = 0.942) and OS (53.9 months vs 60.6 months, p = 0.715) in patients with LVSI.
Limitations: The limitations of this study are the retrospective nature and relative small sample size.
Conclusions: Postoperative radiation seems to prolong PFS and OS in patients with cervical stromal invasion ≥1/2. LVSI was a high-risk factor for tumor recurrence, but radiation after surgery in patients with LVSI seems have no survival benefits.