Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants

Cervical cancer is the third most common cancer in women worldwide. Annually, more than 529,800 new cases occur and the estimated deaths are over 275,000. Of these, over 85% of the cases and the deaths occur in developing countries, including Thailand. Although, cervical cancer is preventable and hi...

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Main Authors: สุธิดา อินทรเพชร, Suthida Intaraphet
Other Authors: นงเยาว์ เกษตร์ภิบาล
Format: Theses and Dissertations
Language:English
Published: เชียงใหม่ : บัณฑิตวิทยาลัย มหาวิทยาลัยเชียงใหม่ 2018
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Online Access:http://cmuir.cmu.ac.th/jspui/handle/6653943832/45955
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Institution: Chiang Mai University
Language: English
id th-cmuir.6653943832-45955
record_format dspace
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
language English
topic Uterine cervix
Clinicopathology
Squamous cell carcinoma
Histological type-specific determinants
spellingShingle Uterine cervix
Clinicopathology
Squamous cell carcinoma
Histological type-specific determinants
สุธิดา อินทรเพชร
Suthida Intaraphet
Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
description Cervical cancer is the third most common cancer in women worldwide. Annually, more than 529,800 new cases occur and the estimated deaths are over 275,000. Of these, over 85% of the cases and the deaths occur in developing countries, including Thailand. Although, cervical cancer is preventable and highly curable when diagnosed at its early stage, patients in developing countries have usually been found with an advanced cancer stage due to the lack of effective screening programs and/or an inability to access the programs. As a result, they have a poor prognosis. Prognostic factors for patients with cervical cancer vary in previous studies, including clinical factors such as age and treatment modality, and pathological factors such as FIGO stage, lymph node involvement, tumor size, lymphovascular space invasion, deep stromal invasion, parametrial involvement and histological type. However, prognostic factors for patients with cervical small cell neuroendocrine (SNEC), a very aggressive and rare histological type, are still controversial due to the rather small sample sizes. Previous studies on SNEC have been limited by the lack of central pathology review for diagnosis of SNEC and/or the variation of treatment modality among institutes of collected cases, which may influence the results. Moreover, conflicting data still exists on the prognostic impact of the histological type on survival in patients with cervical cancer. Additionally, any differences in histological type-specific prognostic factors among cervical SNEC, adenocarcinoma (ADC), and squamous cell carcinoma (SCC) have not yet been clearly identified. All cohort studies in this thesis were carried out at Chiang Mai University Hospital, Chiang Mai, Thailand. Our studies aimed to explore the prognostic factors for cervical SNEC, ADC, and SCC, and evaluate the prognostic value of histology in early and advanced cancer stages among the three histological types. Our findings revealed that the histological type is an independent prognostic factor for patients with cervical cancer. Patients with SNEC had the poorest survival regardless of stage compared with ADC, and SCC. Advanced ADC was associated with a poorer survival compared with SCC while survival between the two was comparable at an early cancer stage. For histological type-specific prognostic factors, age and deep stromal invasion were prognostic factors for cancer-specific survival (CSS) among early stage patients with SNEC, while age and lymph node involvement were prognostic factors for surgically-treated patients with SNEC. For advanced SNEC, age and FIGO stage were found to be prognostic factors. In patients with SCC, deep stromal invasion was a prognostic factor for patients with surgically-treated SCC, and FIGO stage were prognostic factors for advanced stage SCC. Since there were only a few cancer-related deaths in surgically-treated ADC, multivariable analysis could not be performed for this group. For advanced ADC, FIGO stage was the only prognostic factor. We also found the benefit of adjuvant chemotherapy over other types of adjuvant therapy among surgically-treated patients with SNEC, with a significantly higher 5-year CSS rate. However, this finding could have been confounded by confounding by indication, which we did not adjust for. In conclusion, histological type is an independent prognostic factor for patients with cervical cancer, and prognostic factors for patient with cervical cancer differ according to histological type. Adjuvant chemotherapy may provide some benefits for surgically-treated patients with SNEC. Knowledge of histological type-specific prognostic factors and the influence of the histological type on survival should be taken into consideration for tailored treatment and surveillance of treatment outcomes in patients with cervical cancer.
author2 นงเยาว์ เกษตร์ภิบาล
author_facet นงเยาว์ เกษตร์ภิบาล
สุธิดา อินทรเพชร
Suthida Intaraphet
format Theses and Dissertations
author สุธิดา อินทรเพชร
Suthida Intaraphet
author_sort สุธิดา อินทรเพชร
title Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
title_short Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
title_full Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
title_fullStr Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
title_full_unstemmed Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants
title_sort small cell neuroendocrine carcinoma of the uterine cervix: prognostic value of clinicopathology, survival comparing to adenocarcinoma and squamous cell carcinoma, and histological type-specific determinants
publisher เชียงใหม่ : บัณฑิตวิทยาลัย มหาวิทยาลัยเชียงใหม่
publishDate 2018
url http://cmuir.cmu.ac.th/jspui/handle/6653943832/45955
_version_ 1681421660112027648
spelling th-cmuir.6653943832-459552018-03-27T03:09:20Z Small Cell Neuroendocrine Carcinoma of the Uterine Cervix: Prognostic Value of Clinicopathology, Survival Comparing to Adenocarcinoma and Squamous Cell Carcinoma, and Histological Type-Specific Determinants มะเร็งปากมดลูกชนิดสมอลเซลล์นิวโรเอ็นโดไครน์: คุณค่าทำนายของปัจจัยด้านพยาธิวิทยาคลินิก การรอดชีพเปรียบเทียบกับมะเร็งเยื่อบุต่อมและเยื่อบุสแควมัส และปัจจัยชี้เฉพาะของมะเร็งทั้งสามชนิด สุธิดา อินทรเพชร Suthida Intaraphet นงเยาว์ เกษตร์ภิบาล สุมาลี ศิริอังกุล อัญชลี จันทร์แจ่ม Mette Søgaard Uterine cervix Clinicopathology Squamous cell carcinoma Histological type-specific determinants Cervical cancer is the third most common cancer in women worldwide. Annually, more than 529,800 new cases occur and the estimated deaths are over 275,000. Of these, over 85% of the cases and the deaths occur in developing countries, including Thailand. Although, cervical cancer is preventable and highly curable when diagnosed at its early stage, patients in developing countries have usually been found with an advanced cancer stage due to the lack of effective screening programs and/or an inability to access the programs. As a result, they have a poor prognosis. Prognostic factors for patients with cervical cancer vary in previous studies, including clinical factors such as age and treatment modality, and pathological factors such as FIGO stage, lymph node involvement, tumor size, lymphovascular space invasion, deep stromal invasion, parametrial involvement and histological type. However, prognostic factors for patients with cervical small cell neuroendocrine (SNEC), a very aggressive and rare histological type, are still controversial due to the rather small sample sizes. Previous studies on SNEC have been limited by the lack of central pathology review for diagnosis of SNEC and/or the variation of treatment modality among institutes of collected cases, which may influence the results. Moreover, conflicting data still exists on the prognostic impact of the histological type on survival in patients with cervical cancer. Additionally, any differences in histological type-specific prognostic factors among cervical SNEC, adenocarcinoma (ADC), and squamous cell carcinoma (SCC) have not yet been clearly identified. All cohort studies in this thesis were carried out at Chiang Mai University Hospital, Chiang Mai, Thailand. Our studies aimed to explore the prognostic factors for cervical SNEC, ADC, and SCC, and evaluate the prognostic value of histology in early and advanced cancer stages among the three histological types. Our findings revealed that the histological type is an independent prognostic factor for patients with cervical cancer. Patients with SNEC had the poorest survival regardless of stage compared with ADC, and SCC. Advanced ADC was associated with a poorer survival compared with SCC while survival between the two was comparable at an early cancer stage. For histological type-specific prognostic factors, age and deep stromal invasion were prognostic factors for cancer-specific survival (CSS) among early stage patients with SNEC, while age and lymph node involvement were prognostic factors for surgically-treated patients with SNEC. For advanced SNEC, age and FIGO stage were found to be prognostic factors. In patients with SCC, deep stromal invasion was a prognostic factor for patients with surgically-treated SCC, and FIGO stage were prognostic factors for advanced stage SCC. Since there were only a few cancer-related deaths in surgically-treated ADC, multivariable analysis could not be performed for this group. For advanced ADC, FIGO stage was the only prognostic factor. We also found the benefit of adjuvant chemotherapy over other types of adjuvant therapy among surgically-treated patients with SNEC, with a significantly higher 5-year CSS rate. However, this finding could have been confounded by confounding by indication, which we did not adjust for. In conclusion, histological type is an independent prognostic factor for patients with cervical cancer, and prognostic factors for patient with cervical cancer differ according to histological type. Adjuvant chemotherapy may provide some benefits for surgically-treated patients with SNEC. Knowledge of histological type-specific prognostic factors and the influence of the histological type on survival should be taken into consideration for tailored treatment and surveillance of treatment outcomes in patients with cervical cancer. 2018-03-27T03:09:20Z 2018-03-27T03:09:20Z 2014-08 Thesis http://cmuir.cmu.ac.th/jspui/handle/6653943832/45955 en เชียงใหม่ : บัณฑิตวิทยาลัย มหาวิทยาลัยเชียงใหม่