Risk of Ovarian Metastasis and Prognosis in Patients with Neuroendocrine Carcinoma of the Uterine Cervix: A Multi-Center Retrospective Cohort Study.

Objective: To determine the risk of ovarian metastasis and prognosis in patients with neuroendocrine carcinoma of the uterine cervix (NECC). Methods: A retrospective review was conducted of the clinical and pathological information of patients with stage IA2 to IIA2 cervical cancer who underwent radical hysterectomy between 2008 and 2023. Multivariate Cox proportional hazards regression models were used to identify independent prognostic factors for the 5-year overall survival (OS) and disease-free survival (DFS). Results: The study included 1351 patients from four Chinese medical institutions. Compared to those with squamous carcinoma or adenocarcinoma, patients with NECC had a significantly higher risk of lymph vascular space invasion (LVSI) and more frequently received adjuvant radiotherapy. The overall rates of fallopian tube and ovarian metastases were low (< 1.0%). Furthermore, the ovary had a higher rate of metastasis than the fallopian tube (P< 0.001). Remarkably, none of the 75 patients with NECC exhibited fallopian tube or ovarian metastasis. The 5-year DFS and OS were significantly shorter in patients with NECC than in those with squamous carcinoma (5-year DFS, 64.7% vs 90.1%, P < 0.001; 5-year OS, 75.7% vs 89.6%, P < 0.001) or adenocarcinoma (5-year DFS, 64.7% vs 83.4%, P < 0.001; 5-year OS, 75.7% vs 88.7%, P=0.004). Multivariate analysis identified NECC as an independent risk factor for decreased 5-year DFS (aHR, 6.274; 95% CI, 3.749-10.499) and 5-year OS (aHR, 5.925; 95% CI, 3.097-11.336). Sensitivity assessments yielded consistent results. Conclusion: NECC is an independent risk factor associated with a worse prognosis. However, the rates of fallopian tube and ovarian metastases are low in NECC patients, suggesting that ovarian preservation may be a safe and feasible option for these patients. Further validation in broader, diverse populations is warranted to generalize these findings.