Overtreatment risk of postoperative radiotherapy in FIGO I–III cervical small cell neuroendocrine carcinoma: a population-based study
- 1Department of Radiotherapy Oncology, The Second Nanning People’s Hospital
- 2Otorhinolaryngology Head and Neck Surgery Department, The Second Nanning People’s Hospital
Abstract
Background: Cervical small cell neuroendocrine carcinoma (SCNEC) is a rare, highly aggressive cervical malignancy. Radical hysterectomy is standard for localized disease, yet the survival benefit of postoperative radiotherapy (RT) remains controversial. This study assessed postoperative RT’s prognostic impact in SCNEC patients, screened potential RT beneficiaries, and generated evidence to mitigate overtreatment risk.
Methods: Patients with pathologically confirmed FIGO I–III cervical SCNEC diagnosed between 2000 and 2023 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All eligible patients underwent radical hysterectomy. Inverse probability treatment weighting (IPTW) balanced baseline features to reduce selection bias. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Analyses included weighted Kaplan–Meier curves, multivariate Cox regression, and Fine-Gray competing risk models to evaluate RT’s prognostic effect.
Results: A total of 175 eligible patients were identified, among whom 96 (54.9%) received surgery combined with postoperative RT and 79 (45.1%) underwent surgery alone. Before IPTW adjustment, no significant differences in OS or CSS were observed between the two groups. After IPTW, weighted survival analyses showed that postoperative RT did not improve OS (hazard ratio [HR]=1.02, 95% confidence interval [CI]: 0.67–1.54, P = 0.101) and CSS (HR = 1.04, 95%CI: 0.70–1.56, P = 0.198) in the overall cohort. Fine-Gray competing risk analysis further showed that postoperative RT was not associated with reduced cancer-specific mortality (HR = 1.11, 95%CI: 0.73–1.69, P = 0.630). Multivariate Cox regression analysis indicated that year of diagnosis and omission of lymph node resection were independent adverse prognostic factors for both endpoints, and stratified analyses showed no measurable heterogeneity of RT effect across all predefined clinical subgroups.
Conclusion: Postoperative RT was not associated with improved OS or CSS for patients with FIGO stage I–III cervical SCNEC following radical hysterectomy, suggesting a potential overtreatment risk that warrants close clinical attention for this surgically treated population. Given the high malignancy and propensity for systemic metastasis of SCNEC, future studies should focus on integrating immunotherapy strategies targeting the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) axis or delta-like ligand 3 (DLL3) to overcome the limitations of local radiation.
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BibTeX
@article{mo2026overtreatment,
title = {{Overtreatment risk of postoperative radiotherapy in FIGO I–III cervical small cell neuroendocrine carcinoma: a population-based study}},
author = {Dun-Chang Mo and Jian-Feng Huang and Peng-Hui Luo and Xiu-Juan Liang and Long Chen and Shang-Xiao Huang and Han-Lei Wang and Peng Lin},
journal = {Frontiers in Endocrinology},
year = {2026},
month = nov,
doi = {10.3389/fendo.2026.1928841},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1928841/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Overtreatment risk of postoperative radiotherapy in FIGO I–III cervical small cell neuroendocrine carcinoma: a population-based study
AU - Dun-Chang Mo
AU - Jian-Feng Huang
AU - Peng-Hui Luo
AU - Xiu-Juan Liang
AU - Long Chen
AU - Shang-Xiao Huang
AU - Han-Lei Wang
AU - Peng Lin
PY - 2026
DA - 2026/11/03
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1928841
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1928841/full
AB - Background: Cervical small cell neuroendocrine carcinoma (SCNEC) is a rare, highly aggressive cervical malignancy. Radical hysterectomy is standard for localized disease, yet the survival benefit of postoperative radiotherapy (RT) remains controversial. This study assessed postoperative RT’s prognostic impact in SCNEC patients, screened potential RT beneficiaries, and generated evidence to mitigate overtreatment risk. Methods: Patients with pathologically confirmed FIGO I–III cervical SCNEC diagnosed between 2000 and 2023 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All eligible patients underwent radical hysterectomy. Inverse probability treatment weighting (IPTW) balanced baseline features to reduce selection bias. Primary endpoints were overall survival (OS) and cancer-specific survival (CSS). Analyses included weighted Kaplan–Meier curves, multivariate Cox regression, and Fine-Gray competing risk models to evaluate RT’s prognostic effect. Results: A total of 175 eligible patients were identified, among whom 96 (54.9%) received surgery combined with postoperative RT and 79 (45.1%) underwent surgery alone. Before IPTW adjustment, no significant differences in OS or CSS were observed between the two groups. After IPTW, weighted survival analyses showed that postoperative RT did not improve OS (hazard ratio [HR]=1.02, 95% confidence interval [CI]: 0.67–1.54, P = 0.101) and CSS (HR = 1.04, 95%CI: 0.70–1.56, P = 0.198) in the overall cohort. Fine-Gray competing risk analysis further showed that postoperative RT was not associated with reduced cancer-specific mortality (HR = 1.11, 95%CI: 0.73–1.69, P = 0.630). Multivariate Cox regression analysis indicated that year of diagnosis and omission of lymph node resection were independent adverse prognostic factors for both endpoints, and stratified analyses showed no measurable heterogeneity of RT effect across all predefined clinical subgroups. Conclusion: Postoperative RT was not associated with improved OS or CSS for patients with FIGO stage I–III cervical SCNEC following radical hysterectomy, suggesting a potential overtreatment risk that warrants close clinical attention for this surgically treated population. Given the high malignancy and propensity for systemic metastasis of SCNEC, future studies should focus on integrating immunotherapy strategies targeting the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) axis or delta-like ligand 3 (DLL3) to overcome the limitations of local radiation.
SN - 1664-2392
ER -