Clinical characteristic and prognostic factors in high‐grade endometrial neuroendocrine carcinoma

Abstract

Aim:The aim of the present study was to summarize the clinical characteristics and analyze the independent prognostic factors in patients with high-grade endometrial neuroendocrine carcinoma (ENC). Methods: Patients diagnosed with ENC, endometrioid adenocarcinoma (EAC), endometrial clear-cell carcinoma (ECC), endometrial serous carcinoma (ESC), endometrioid carcinoma with mucinous features (EMC) from 1987 to 2016 were screened from the National Cancer Institute database (surveillance, epidemiology, and end results [SEER]). Kaplan-Meier were used to assess survival. Univariate and multivariate Cox proportional hazards analysis were done to examine factors affecting survival. Results: The median survival times of ENC were 11 months, shorter than that of EAC, ECC, ESC, and EMC (p < 0.01). There was no significant difference in ages, survival rate, and median survival time between largecell ENC (LCENC) and small-cell ENC (SCENC), which were all belong to ENC. In a multivariable model, the hazard ratio (HR) of death for women with Federation International of Gynecology and Obstetrics (FIGO) stage I-II of ENC was 0.37 compared to FIGO stage III-IV (p < 0.01). The HR of patients who under the surgery was 0.39 compared to the patients who without surgery (p < 0.01), and the HR of patients who received chemotherapy was 0.51 compared to the patients who did not received chemotherapy (p < 0.01). Radiotherapy did not significantly reduce the mortality risk of patients. Conclusion: ENC was a kind of devastating endometrial cancers with the poorest prognosis. Surgical treatment and chemotherapy were necessary for improving prognosis of ENC. Early diagnosis favored better prognosis. There was no prognostic difference between with and without radiotherapy.

Extrapulmonary Neuroendocrine Carcinomas: Current Management and Future Perspectives

“…The most frequent clinical manifestations are unusual uterine bleeding or symptomatic metastases [105]. Endometrial NECs, which include smalland large-cell neoplasms, are highly aggressive cancers that entail more than double the risk of death compared to their non-neuroendocrine counterparts [104,106]. The average age of diagnosis is about 66 years [106] and in approximately 70% of cases, endometrial NECs are advanced tumors at diagnosis (FIGO stage III or IV) [68], with a reduced OS of 12 months when compared to 22 months in stages I-II [107].…”

“…Endometrial NECs, which include smalland large-cell neoplasms, are highly aggressive cancers that entail more than double the risk of death compared to their non-neuroendocrine counterparts [104,106]. The average age of diagnosis is about 66 years [106] and in approximately 70% of cases, endometrial NECs are advanced tumors at diagnosis (FIGO stage III or IV) [68], with a reduced OS of 12 months when compared to 22 months in stages I-II [107]. Unlike endometrioid and undifferentiated carcinomas that present a focal positivity for neuroendocrine markers, the majority of endometrial NECs present a diffuse positivity for more than two neuroendocrine markers among neuron-specific enolase (NSE), CgA, synaptophysin, and CD56 [77].…”