Retrospective two-center study associates postoperative radiotherapy with improved survival in 33 high-risk patients with neuroendocrine cervical carcinoma

The published abstract of a retrospective multicenter cohort study reports that postoperative radiotherapy was associated with better survival among patients with limited-stage high-grade neuroendocrine cervical carcinoma who had lympho-vascular invasion, deep stromal invasion and perineural invasion. The analysis included 199 patients treated between 2005 and 2022 at two Chinese institutions. This high-risk subgroup contained 33 patients, a small number that limits interpretation of the treatment comparison.

Researchers used recursive partitioning analysis to divide the cohort into three groups using preselected clinicopathological variables: age, FIGO stage, tumor size, lympho-vascular invasion, deep stromal invasion and perineural invasion. The low-risk group comprised 96 patients without lympho-vascular invasion or deep stromal invasion. The intermediate-risk group included 70 patients with lympho-vascular invasion and deep stromal invasion but without perineural invasion. The high-risk group consisted of 33 patients with all three pathological features. Relative to the low-risk group, the reported hazard ratios were 3.60 for the intermediate-risk group (95% CI 1.95–6.67; p<0.001) and 6.22 for the high-risk group (95% CI 3.23–11.95; p<0.001).

Postoperative radiotherapy did not significantly improve survival in the overall cohort, with all reported p-values greater than 0.05. The association differed by risk group: among the 33 high-risk patients, radiotherapy was associated with a five-year overall survival of 41.9%, compared with 0% among those who did not receive radiotherapy. The reported hazard ratio for postoperative radiotherapy in this subgroup was 0.22 (95% CI 0.08–0.58; p<0.001). No mortality reduction was observed in the intermediate-risk group (p=0.890) or the low-risk group (p=0.980).

The abstract describes a two-institution retrospective design rather than a randomized trial. Evaluations of radiotherapy used stratified Kaplan–Meier analysis and Cox proportional hazards models, while variables in the risk model were weighted according to hazard ratios from univariate and multivariable Cox regression. The findings therefore identify patient subgroups in which postoperative radiotherapy was associated with survival differences, but they do not establish that radiotherapy caused the observed outcomes. The abstract itself calls for prospective validation before the risk-stratified approach can be considered established, and it does not provide information about treatment allocation, confounding, toxicity or the reasons for withholding radiotherapy.

Subject of Research: Risk-stratified postoperative radiotherapy associations in limited-stage high-grade neuroendocrine cervical carcinoma

Article Title: Postoperative radiotherapy for limited-stage high-grade neuroendocrine cervical carcinoma: a retrospective multi-center study from two Chinese institutions

Article References: Yang, X., Wen, J., Tang, Q., Aili, Y., Chen, M., Cao, X., Chen, Y., Li, Y., Ren, Y., & He, S. (2026). Postoperative radiotherapy for limited-stage high-grade neuroendocrine cervical carcinoma: a retrospective multi-center study from two Chinese institutions. BMC Cancer. https://doi.org/10.1186/s12885-026-16959-3

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16959-3

Keywords: neuroendocrine cervical carcinoma, postoperative radiotherapy, high-grade cervical cancer, recursive partitioning analysis, lympho-vascular invasion, deep stromal invasion, perineural invasion, survival, retrospective cohort, risk stratification, Postoperative, radiotherapy