Prognostic value of inflammatory markers and different treatment regimens in neuroendocrine cervical carcinoma: a retrospective study

Abstract

Background: Neuroendocrine cervical carcinoma (NECC) is a rare and highly aggressive gynecological tumor, with poor prognosis and limited standardized treatment options. Inflammation plays a significant role in tumor progression, and systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have shown prognostic value in other malignancies. However, their role in NECC remains unclear.

Methods: This single-center retrospective study included 25 NECC patients treated at our hospital between 2014 and 2024. Patients were divided into three groups based on treatment regimens: paclitaxel plus cisplatin combined with radiotherapy, etoposide plus cisplatin combined with radiotherapy, and radiotherapy alone. Baseline characteristics, inflammatory markers, and clinical outcomes were analyzed. Kaplan-Meier survival analysis and Log-rank tests were used to compare survival differences.

Results: The median survival time was significantly longer in the etoposide plus cisplatin plus radiotherapy group (1,000 days) compared to the paclitaxel plus cisplatin plus radiotherapy group (776 days) and the radiotherapy-alone group (347 days, P = 0.037). The radiotherapy-alone group had significantly higher neutrophil counts (median = 5.46 × 10⁹/L, P = 0.006), platelet counts (median = 282.5 × 10⁹/L, P = 0.017), NLR (median = 4.68, P < 0.05), and PLR (median = 231.93, P < 0.05), while LMR (median = 1.89, P < 0.05) was lower. For postoperative patients, the median survival time was 1,453 days for the surgery plus etoposide plus cisplatin plus radiotherapy group, compared to 987 days for the surgery plus paclitaxel plus cisplatin plus radiotherapy group (P = 0.048).

Conclusion: Combined chemotherapy with etoposide plus cisplatin and radiotherapy significantly improves survival outcomes in NECC patients compared to radiotherapy alone. This regimen may be particularly beneficial for postoperative patients and those with high-risk factors such as lymphovascular space invasion. Further studies are needed to validate these findings and establish standardized treatment protocols for NECC.

Keywords: clinical research; inflammatory markers; neuroendocrine cervical carcinoma; prognosis; retrospective study.

FIGURE 1

Patient Screening and Enrollment Flowchart. This figure illustrates the process of screening and enrolling patients with NECC from January 2014 to December 2024. A total of 37 patients were initially screened, with 12 excluded due to incomplete data (5 patients who did not receive any treatment after diagnosis, 3 with partial data missing, and 4 with failed follow-up).

FIGURE 2

Radiotherapy Field and Dose Distribution Maps. (A,B) The tumor coverage for partially NECC patients receiving a radiotherapy dose of 45Gy, with coverage reaching 99.4881%. (C,D) The similar coverage of 99.2221% for the other patients. These results demonstrate the high accuracy of the radiotherapy treatment range.

FIGURE 3

Correlation Heatmap of Blood Indicators and Inflammatory Markers. This heatmap displays the correlations between SCCA, NLR, LMR, and ALB. LMR is significantly negatively correlated with NLR. Albumin shows a moderate negative correlation with NLR. * indicates p < 0.05, ** indicates p < 0.01, and *** indicates p < 0.001.

FIGURE 4

Histological Subtypes of NECC Patients. (A) 13 patients with cervical neuroendocrine carcinoma combined with partial squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma. (B) 22 patients with pure cervical neuroendocrine carcinoma.

FIGURE 5

Clinical and Pathological Characteristics by Treatment Group. (A) HPV positivity rates (40% in the etoposide plus cisplatin plus radiotherapy group, 20% in the paclitaxel plus cisplatin plus radiotherapy group, and 25% in the radiotherapy-alone group, P = 0.042). (B) DMI rates (60% in the etoposide group, 25% in the paclitaxel group, and 30% in the radiotherapy-alone group, P = 0.038). (C) LVSI rates (100% in the radiotherapy-alone group, 20% in the paclitaxel group, and 60% in the etoposide group, P = 0.018). (D) Tumor stage distribution (50% Stage I in both chemotherapy groups, 75% Stage II in the radiotherapy-alone group, P = 0.075).

FIGURE 6

Survival Curves by Treatment Regimen. (A) Patients receiving combined chemotherapy (etoposide plus cisplatin plus radiotherapy and paclitaxel plus cisplatin plus radiotherapy) had significantly better survival compared to those receiving radiotherapy alone (P = 0.011). (B) Compares the survival curves of the two chemotherapy regimens, showing no significant difference (P = 0.18). (C) Postoperative patients receiving surgery plus etoposide plus cisplatin plus radiotherapy had significantly better survival compared to those receiving surgery plus paclitaxel plus cisplatin plus radiotherapy (P = 0.041).