Factors Affecting Survival of Patients with Cervical Cancer
-
Mohammadreza Balooch Hasankhani
,
Yunes Jahani
,
Azam Bazrafshan
,
Ashraf Yazdizadeh
,
Ali Karamoozian
Abstract
Background: Cervical cancer is the fourth leading cause of cancer-related death among women worldwide. We aimed to identify the factors affecting the survival rate of cervical cancer patients, as these factors are vital for preventing the progression and effective treatment of cancer.
Methods: In this retrospective cohort study, 254 patients with cervical cancer who were registered in The Kerman Population-Based Cancer Registry (KPBCR) between 2012 and 2022 and whose status was known to be alive or dead were enrolled. Since the proportional hazard assumption was not established for the type of treatment, the extended Cox model was used to determine the variables influencing the survival of the patients.
Results: The mean survival time of the patients was 91.28 ± 3.02 months. The results of fitting the extended Cox model showed that the risk of death increases by 1.02 per year of age at diagnosis (HR=1.02; 95% CI: 1.00, 1.04). Moreover, for a one-unit increase in body mass index (BMI), the risk of death increased by 0.93 (HR=0.93; 95% CI: 0.88, 0.98). The risk of death in patients with disease stages III&IV was 3.08 times that of patients with disease stages I&II (HR=3.08; 95% CI: 1.05, 9.03). The risk of death in patients receiving at least one of the radiotherapy and chemotherapy treatments after 18 months was 7.11 times that of patients undergoing surgery (HR=7.11; 95% CI: 1.69, 29.91).
Conclusion: The age of diagnosis, BMI, disease stage, and type of treatment significantly affect the survival of patients. Thus, raising women's awareness of periodical examinations and early diagnosis can reduce the risk of death and prevent cervical cancer progression.
2. Sung H, Ferlay J, Siegel RL, et al (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 71(3): 209-49.
3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 68(6): 394-424.
4. Atun R, Jaffray DA, Barton MB, et al (2015). Expanding global access to radiotherapy. Lancet Oncol, 16 (10): 1153-86.
5. Ferlay J, Soerjomataram I, Dikshit R, et al (2012). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer, 136 (5): E359-86.
6. Shahesmaeili A, Afshar RM, Sadeghi A, Bazrafshan A (2018). Cancer incidence in Kerman Province, Southeast of Iran: report of an ongoing population-based cancer registry, 2014. Asian Pac J Cancer Prev, 19 (6): 1533-41.
7. Seifu B, Fikru C, Yilma D, Tessema F (2022). Predictors of time to death among cervical cancer patients at Tikur Anbesa specialized hospital from 2014 to 2019: A survival analysis. PLoS One, 17 (2): e0264369.
8. Tshewang U, Satiracoo P, Lenbury Y (2021). Survival Analysis of Cervical Cancer Patients: A Case Study of Bhutan. Asian Pac J Cancer Prev, 22 (9): 2987-93.
9. Mascarello KC, Zandonade E, Amorim MHC (2013). Survival analysis of women with cervical cancer treated at a referral hospital for oncology in Espírito Santo State, Brazil, 2000-2005. Cad Saude Publica, 29 (4): 823-31.
10. Purnami S, Inayati K, Sari NW, Chosuvivatwong V, Sriplung H (2016). Survival analysis of cervical cancer using stratified Cox regression. AIP Conference Proceedings, 1723.
11. Therneau TM, Grambsch PM (2000). The cox model. Modeling survival data: extending the Cox model. Springer, pp.: 39-77.
12. Klein JP, Moeschberger ML (2003). Survival analysis: techniques for censored and truncated data. New York, Springer.
13. Quinn BA, Deng X, Colton A, Bandyopadhyay D, Carter JS, Fields EC (2019). Increasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival. Brachytherapy, 18 (1): 29-37.
14. Khalkhali HR, Gharaaghaji R, Valizadeh R, Kousehlou Z, Ayatollahi H (2019). Ten years’ survival in patients with cervical cancer and related factors in West Azerbaijan Province: Using of cox proportion hazard model. Asian Pac J Cancer Prev, 20 (5): 1345-51.
15. Sims TT, El Alam MB, Karpinets TV, et al (2021). Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation. Commun Biol, 4 (1): 237.
16. Jou J, Coulter E, Roberts T, et al (2021). Assessment of malnutrition by unintentional weight loss and its implications on oncologic outcomes in patient with locally advanced cervical cancer receiving primary chemoradiation. Gynecol Oncol, 160 (3): 721-8.
17. Serur E, Fruchter RG, Maiman M, McGuire J, Arrastia CD, Gibbon D (1995). Age, substance abuse, and survival of patients with cervical carcinoma. Cancer, 75 (10): 2530-8.
18. Patel K, Foster NR, Kumar A, et al (2015). Hydronephrosis in patients with cervical cancer: an assessment of morbidity and survival. Support Care Cancer, 23 (5): 1303-9.
19. Dueňas-González A, Orlando M, Zhou Y, Quinlivan M, Barraclough H (2012). Efficacy in high burden locally advanced cervical cancer with concurrent gemcitabine and cisplatin chemoradiotherapy plus adjuvant gemcitabine and cisplatin: prognostic and predictive factors and the impact of disease stage on outcomes from a prospective randomized phase III trial. Gynecol Oncol, 126 (3): 334-40.
20. Juhan N, Abd Razak N, Zubairi YZ, Khattak MN, Naing NN (2013). Survey of Patients with Cervical Cancer in Hospital UniversitiSains Malaysia: Survival Data Analysis with Time-Dependent Covariate. Iran J Public Health, 42 (9): 980-7.
21. Janicek MF, Averette HE (2001). Cervical cancer: prevention, diagnosis, and therapeutics. CA Cancer J Clin, 51 (2): 92-114.
22. Šarenac T, Mikov M (2019). Cervical cancer, different treatments and importance of bile acids as therapeutic agents in this disease. Front Pharmacol, 10: 484.
23. American Cancer Society (2021). Treatment options for cervical cancer, by stage. Updated: 3 January 2021. Available from: https://www.cancer.org/cancer/cervical-cancer/treating/by-stage.html.
24. Bulletins‐Gynecology ACoP (2002). Diagnosis and Treatment of Cervical Carcinomas. Int J Gynaecol Obstet, 78 (1): 79-91.
25. Eaker S, Adami H-O, Sparén P (2001). Reasons women do not attend screening for cervical cancer: a population-based study in Sweden. Prev Med, 32 (6):482-91.
26. Waggoner SE (2003). Cervical cancer. Lancet, 361(9376):2217-25.
27. Zarchi MK, Akhavan A, Fallahzadeh H, Gholami H, Dehghani A, Teimoori S (2010). Outcome of cervical cancer in Iranian patients according to tumor histology, stage of disease and therapy. Asian Pac J Cancer Prev, 11 (5): 1289-91.
28. Muhamad NA, Kamaluddin MA, Adon MY, et al (2015). Survival rates of cervical cancer patients in Malaysia. Asian Pac J Cancer Prev, 16 (7): 3067-72.
29. Chung H, Jang M, Jung K, et al (2006). Members for Gynecologic Oncology Committee of Korean Society of Obstetrics and Gynecology. Cervical cancer incidence and survival in Korea 1993-2002. Int J Gynecol Cancer, 16 (5): 1833-8.
| Files | ||
| Issue | Vol 52 No 10 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v52i10.13860 | |
| Keywords | ||
| Cervical cancer Survival Prognostic factor Time-dependent covariate Extended cox model | ||
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