Exploring and detecting predictors associated with survival and mortality of cervical cancer patients: a 10-year retrospective study

Abstract

Background

Cervical cancer is the 4th most prevalent cancer among females globally. In India, approximately 123,907 women are diagnosed with cervical cancer every year, leading to 77,348 deaths annually. However, Indian healthcare system lacks the sufficient information regarding the factors influencing survival and mortality among cervical cancer patients at regional levels. Thus, we aimed to identify the predictors associated with survival outcomes and mortality rates among cervical cancer.

Methods

A retrospective cohort study was conducted over 8 months at a tertiary care hospital where 10-year (January 2013–December 2022) data of cervical cancer patients were analyzed from medical record department (MRD). Telephonic interviews were carried out with patients or patient parties to know the survival status of patients. The data was analyzed using descriptive statistics, Kaplan–Meier curve, log-rank test and Cox regression.

Results

Out of 330 cervical cancer patients, majority (64.24%) were > 50 years of age followed by 35.76% were < 50 years. Most of the patients had abnormal body mass index (BMI) (46.96%), postmenopausal stage (75.76%), stage II cancer (43.03%), histologically poorly differentiated grade (47.88%) and squamous cell carcinoma (87.88%), with radiation plus chemotherapy being popular treatment choice (48.79%) and with the overall mean age of 56 years. Age, BMI, menopause, stage of cancer, histological grades and types of treatment were found to be significant predictors (p < 0.05) of survival among cervical cancer patients. Using cox regression analysis, advanced age (age > 50 years: hazard ratio (HR): 1.82), underweight (BMI < 18.5: HR:1), postmenopause (HR:1), advanced stage of cervical cancer (Stage I, Stage II, Stage III, Stage IV: HR:1, HR:2.78, HR:10.08, HR:20.81), poorly differentiated cervical cancer (HR:1.70), radiation therapy (HR:4.86), chemotherapy (HR:6.55) or chemoradiation therapy (HR:3.31) and surgery plus chemotherapy (HR: 4.55) were identified to be significant predictors of mortality among cervical cancer patients.

Conclusion

We conclude that the 5- and 10-year survival rates for cervical cancer patients were found to be 51.2% and 42.9%, respectively. Advanced age, underweight, postmenopausal status, advanced cancer stage, poor cancer cell differentiation and chemotherapy-based treatment were significant predictor of mortality and vice-versa for survival which might guide clinicians and policymakers in making informed clinical decisions to combat cervical cancer.