Impact of regional lymph node surgery and lymph node status on survival of small cell cervical cancer patients undergoing primary site surgery

OBJECTIVE: Small cell carcinoma of the cervix (SCCC) is a rare and highly aggressive malignancy with limited evidence to guide surgical management. We therefore aimed to evaluate the prognostic value of regional lymph node (LN) surgery and LN status in patients with SCCC undergoing primary tumor resection. METHODS: In this retrospective cohort study, data were obtained from the Surveillance, Epidemiology, and End Results database (January 1, 2000 to December 31, 2021). A total of 204 patients with histologically confirmed SCCC who underwent primary tumor resection were included and classified according to receipt of regional LN surgery. An independent validation cohort with 121 patients was retrospectively identified from our center (January 1, 2013 to December 31, 2020). Kaplan-Meier curves, multivariable Cox proportional hazards models, and stratified subgroup analyses were performed. RESULTS: Of the 204 included patients, 141 (69.1%) underwent regional LN surgery and 63 (30.9%) did not. Baseline demographic and clinicopathologic characteristics were similar between groups. In patients with International Federation of Gynecology and Obstetrics (FIGO) stage I-IVA disease, regional LN surgery was not associated with improved cancer-specific survival (CSS) (adjusted hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.52-2.56; P = 0.722), and LN-negative status was not prognostic. Among those with stage IVB disease, LN surgery was associated with significantly better survival (adjusted HR, 0.24; 95% CI, 0.08-0.77; P = 0.016). In the independent validation cohort, LN status was not significantly associated with recurrence-free survival (HR, 1.163; 95% CI, 0.37-3.61; P = 0.794) or CSS (HR, 1.39; 95% CI, 0.44-4.40; P = 0.575). CONCLUSION: Regional LN surgery did not improve survival among patients with FIGO stage I-IVA SCCC, and LN status alone was not an independent prognostic indicator. However, LN surgery may confer potential benefit in FIGO stage IVB disease. These findings suggest that LN dissection should be considered carefully and highlight the need for individualized surgical decision-making and prospective validation.