Epidemiology and treatment options for cervical cancer patients aged <25 Years based on SEER database and real world...

To characterize epidemiology, treatment efficacy, and prognosis in cervical cancer patients aged <25 years using SEER data and institutional validation, and propose personalized strategies.

We analyzed 73,869 SEER database patients (2000-2021), including 544 aged <25 years. Epidemiological trends, histology, and staging were assessed. Survival models compared 3-/5-year survival rates: surgical (n = 25) vs. non-surgical (n = 9) treatment for stage IB3; surgical (n = 18) vs. non-surgical (n = 4) for stage IIA2; and adjuvant chemotherapy (n = 51) vs. non-chemotherapy (n = 6) for stages IIIA-IIIB. Findings were validated against institutional data (n = 12; 2009-present).

Among SEER Database, the proportion of young patients significantly declined from 1.36% (2004) to 0.39% (2021), with poorly differentiated carcinoma predominating (51.65%). Squamous cell carcinoma accounted for the majority (59.56%), rare histological subtypes accounted for (12.68%) including small cell neuroendocrine carcinoma and clear cell carcinoma, with notable prognostic implications. Most young patients presented with early-stage disease (77.94%, n = 298/424). For stage IB3, surgery yielded higher 3-year (84% vs 55.56%) and 5-year survival (80% vs 44.44%) than non-surgical management. Stage IIA2 comparisons showed conflicting trends (potentially due to small samples). In stages IIIA-IIIB, adjuvant chemotherapy was associated with trends toward improved survival, and cumulative risk analysis suggested a potential reduction in long-term mortality risk in the chemotherapy group versus non-chemotherapy. Institutional data mirrored SEER treatment patterns. Histologic subtype emerged as a critical prognostic determinant; Both institutional deaths occurred in patients with rare histologies (stage IVB small cell neuroendocrine carcinoma; stage IIB clear cell carcinoma), suggesting histology may represent an important prognostic factor, potentially interacting with stage.

Most young cervical cancer patients present with early-stage, poorly differentiated disease. Surgery may be beneficial for early-stage (≤IIB) disease in selected patients localized disease, while concurrent chemoradiotherapy (CCRT) plus brachytherapy remains the standard for advanced stages (IIIA-IIIB); the role of Adjuvant chemotherapy did not demonstrate a significant survival benefit and should be interpreted with caution. Tumor histology may outweigh stage as a prognostic determinant in this population. These findings are exploratory and require validation in prospective studies.