Objective: An evaluation of the prognostic factors of patients with surgically treated high-grade neuroendocrine carcinoma of the cervix (NECC). Design: A multi-center, retrospective analysis Setting and Population: 58 cases Methods: 58 patients with stage IIA1-IIIC cervical cancer who had high-grade NECC and were initially treated with surgery between 2009 and 2022 was conducted. We divided them into two groups based on pathology: the pure cohort (only one histological type) and the mixed group (≥2 histological types). All clinicopathological characteristics of patients were reviewed retrospectively using electronic medical records. Main Outcome Measures: Survival outcomes of NECC, clinicopathological characteristics and various related factors were analysed. Results: The median overall survival (OS) was 32.5 months (range: 4.1–60.9). The mixed pathology was a protective factor impacting survival outcomes in NECC (HR,0.02; 95% CI, 0.00~0.45, P=0.014). In contrast, uterus invasion (HR, 24.5; 95%CI, 1.37~439.31, P=0.03) was a poor prognostic factor affecting the survival outcomes in NECC. In addition, among all postoperative adjuvant chemotherapy options, etoposide + platinum (EP) showed better survival outcome (HR,0.04; 95% CI, 0.00~0.89, P=0.041). According to the Kaplan-Meier survival curves, significant differences were observed with respect to mixed pathology (P=0.044), uterus invasion (P＜0.0001), parametrium invasion (P=0.025), surgical margin (P=0.035), and distant metastasis (P＜0.0001). Conclusions: Patients with mixed pathological subtypes who undergo surgery for NECC have a better prognosis. Meanwhile, uterus invasion is a poor predictor of prognosis. In terms of postoperative adjuvant chemotherapy, the EP regimen is superior to other regimens. (The trial registration number: ChiCTR2200063023)