Transcriptomic analyses of high-grade neuroendocrine carcinoma of gynecologic origin

High-grade neuroendocrine carcinomas (NECs) of the cervix are rare, aggressive cancers accounting for about 1-1.5% of all cervical cancer. The 5-year survival is up to 36% for early-stage disease; however, the advanced-stage disease has <10% survival, with relapse rates exceeding 90%. These cancers are likely to have a vascular invasion and nodal or visceral metastasis. Unfortunately, NEC of the cervix affects young women with a median age of 37. High-grade NECs of other gynecologic origins are even rarer, share similar aggressive behavior and poor outcomes. We performed stranded paired-end RNA-seq of 13 samples, including 12 samples with matched whole exome sequencing (WES) data. Sites of origin for tumors in our cohort were the cervix (69%), ovary (19%), and endometrium (12%). The median number of prior lines of therapy was 1. Median PFS and OS were 1 and 12 months, respectively, indicating their highly lethal nature. Comparing transcriptomic profiles with TCGA cervical and ovarian cancers, chromatin assembly and nucleosome organization were the top GO functions for significantly over-expressed genes in our cohort. Remarkably, under-expressed genes in our cohort were enriched for protein modification and catabolic processes, and neutrophil-mediated immunity. Compared to small cell lung cancer (SCLC), our cohort showed highly distinct transcriptomic patterns, and represented the YAP1 high molecular subtype. We performed stranded paired-end RNA-seq of 13 FFPE tumor samples.