Objective  To investigate the effect of the FIGO 2018 staging system on the treatment strategy and prognosis of patients with neuroendocrine carcinoma of the uterine cervix (NECUC).

  Methods  Sixty-five patients with NECUC treated at Chongqing University Cancer Hospital between January 2003 and January 2019 were retrospectively reviewed and compared using the FIGO 2018 staging system, and FIGO 2009 staging system. A univariate Log-rank test and multivariate Cox regression models were used for the analysis.

  Results  The median age was 46 years (range18-70 years), and the median follow-up time was 23.6 months (range4-151 months). Forty-two patients underwent radical surgery, 16 patients received concurrent chemoradiation, 3 patients received chemotherapy alone, and 4 patients refused all treatments. As of the follow-up data, 38 patients had died, and 42 patients had relapsed. According to the FIGO 2018 staging system, 34 of the 65 patients (52.3%) experienced stage upgrades, with most of the changes occurring in stages ⅠB andⅢC. The 2-year progression-free survival (PFS) rate and overall survival (OS) rate were 40.5% and 50.5%, respectively. The univariate analysis showed that prognosis was significantly related to the FIGO stage, radiotherapy, chemotherapy, and the number of courses of chemotherapy (all P < 0.05), while the tumor size and chemotherapy regimens were not significantly associated with prognosis (all P>0.05). The multivariate analysis found that radiotherapy was an independent factor for PFS, while the FIGO 2018 staging system and the number of chemotherapy courses were independent factors of OS.

  Conclusions  The FIGO 2018 staging system is superior to the old staging system in judging the prognosis of patients with NECUC. It is especially useful for evaluating the lymph node status by preoperative imaging at an early stage. Sufficient chemotherapy courses and radiotherapy may be beneficial in improving survival.