Indicators of survival and prognostic factors in women treated for cervical cancer at a tertiary care center in Saudi Arabia

Abstract

BACKGROUND: Investigating survival in cervical cancer at the local level is crucial to determine the effectiveness of overall management, as it reflects the level of care provided and awareness among the population about screening and early diagnosis. OBJECTIVES: Analyze overall survival (OS) and disease-free survival (DFS) among patients treated for cervical cancer and to investigate clinical, management-and outcome-related independent factors associated with survival. DESIGN: A retrospective medical record review. SETTING: Gynecology oncology unit in a tertiary care center. PATIENTS AND METHODS: All women with cervical cancer who were treated and followed up between January 1999 and December 2017. Baseline demographic and clinical data, tumor characteristics, treatment options and outcomes including recurrence were collected and analyzed as factors and predictors of survival. MAIN OUTCOME MEASURES: OS and DFS among patients treated for cervical cancer. SAMPLE SIZE: 190 patients. RESULTS: The 190 patients had a mean (SD) age of 54.2 (13.1) years (median 52.0, interquartile range, 46-62), and median (IQR) follow-up time was 37.0 (12.0-69.0) months. Tumor characteristics showed FIGO stage (I [19.0%], II [48.9%], III [18.4%], IV [13.6%]), grade (I [15.8%], II [46.8%], III [35.8%]) and the most frequent histological type was squamous cell carcinoma (77.4%). Patients received initial radiotherapy with concurrent chemotherapy (53.2%), initial radical hysterectomy (24.7%), systemic chemotherapy (6.3%) and palliative care (4.7%). Mean OS and DFS were 97.1 (82.2, 111.9) and 85.2 (70.4, 100.0) months, respectively. Recurrence and mortality rates were 25.8% and 46.8%, occurring after a median (IQR) time=13.0 (6.0-28.0) and 20.0 (9.0-45.0) months, respectively. Survival was independently associated with grade II (hazard ratio [HR]=3.6, 95%CI: 1.3-9.7, P=.012), grade III (HR=4.5, 95%CI:1.6-12.6, P=.004), number of regional organs involved (1-3 organs: HR=7.8, 95%CI: 1.2, 49.1, P=.030), and recurrence (HR=2.23, P=.001). CONCLUSION: Survival was about 8 years in our institution, which is predicted by the tumor grade, regional organs involved and recurrence. Remarkably, this study found a high percentage of patients diagnosed at an advanced stage, which probably impacts survival and stresses the need for improving early detection. LIMITATIONS: Retrospective design, resulting in recall bias and missing data. CONFLICT OF INTEREST: None.

Associated predictor covariates of cervical cancer and impact on survival at Khartoum oncology hospital, Sudan

“…In a four step elimination process of confounding factors, the results confirmed strongly that stage, chemotherapy and radiotherapy were the most likely predictor covariates of survival times. This result was in agreement with a recent study in Saudia Arabia 31 . Though the late cancer stage at diagnosis has proven to be closely related to poor survival, there are other factors associated with low survival rates such as socio-demographic, cultural, and economic characteristics of the patient, and histopathological features of the tumor 12 .…”

Associated predictor covariates of cervical cancer stage and impact on survival at Khartoum oncology hospital, Sudan

“…This result was in agreement with a recent study in Saudia Arabia. 31 Though the late cancer stage at diagnosis has proven to be closely related to poor survival, there are other factors associated with low survival rates such as socio-demographic, cultural, and economic characteristics of the patient, and histopathological features of the tumor. 12 Aside from the impacted survival rate, diagnosis of cervical cancer at an advanced stage has been explained by delays in diagnosis at presentation and initiation of treatment.…”

A scoping review on population-centered indicators for cancer care continuum

“…The number of most published articles included five studies in Korea (12, 20, 37, 38, 42) and the United States (11,14,21,26,32), three studies in the Netherlands (23, 25, 27) and multinationals (16, 29,33), and two studies in Switzerland (13,34), Australia (31, 41), Canada (19,43), and Europe (17,36). Only one least published study was included from the American Society of Cancer Organization (ASCO) (15), China (44), France (24), Italy (39), Morocco (28), Norway (35), Saudi Arabia (40), the UK (45), and Spain (18), and according to the year of publication, 75% of the articles were published between 2017 and 2020, indicating that the selected articles were relatively new with different details (Supplementary Figure S1). The number of studies on target cancers in selected articles included seven studies focused on all types of cancers (12, 20,21,36,42,43,45), six studies on colorectal (13,17,25,27,32,33), five studies on breast (23, 28,35,39,44), three studies on cervical (16, 30, 40), lung (37,38,41), and bladder (11,14,19), two studies on each ovarian (24, 26) and prostate (29,…”