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Impact of Various Prognostic Factors on Overall Survival, Disease-Free Survival and Patterns of Failure in Carcinoma Cervix: A Tertiary Care Centre Experience from South India

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Purpose

As per GLOBACON 2012, the incidence of cervical cancer is 22.9% with a mortality rate of 54.9% (http://globocan.iarc.fr, 2010). As the disease affects relatively younger population, high fatality rate impacts family and society in a disastrous way. Cervical carcinoma has a relatively poor prognosis due to advanced stage at presentation. We retrospectively analysed the treated cases of carcinoma cervix to know the impact of various prognostic factors on survival and patterns of failure in our hospital.

Methods

All cases treated from 2010 to 2015 (total 920 pts) who completed curative treatment in a tertiary care hospital were analysed to evaluate overall survival, disease-free survival, factors impacting survival, patterns of failure, factors affecting failure, mortality, and treatment-related toxicity. OS and DFS were calculated with Kaplan–Meier method, and log-rank test was used to identify the difference between groups. Failure factors were correlated with logistic regression, and toxicity was expressed in percentage.

Results

Univariate and multivariate analyses were performed. Pre treatment staging, lymphadenopathy, imaging used for diagnosis, hemoglobin levels extent of vagina involved and during treatment usage of concurrent chemotherapy, dose of radiation used, development of neutropenia and aftercompletion of treatment type of response had shown significant impact on DFS and OS. The presence of lymphadenopathy, increasing involvement of vagina, low pretreatment haemoglobin levels, and not receiving chemotherapy had increased risk of failure, while pretreatment evaluation with CT or MRI decreased the risk of failure. Para-aortic nodes (28%) were the commonest among distant failures. Acute bowel toxicity and radiation proctitis were commonly seen.

Conclusions

Presentation in locally advanced stage decreases survival; hence, detection in early stages by population-based screening programmes is needed. Pretreatment imaging with MRI/CT improves staging and thereby improves survival. There is no impact of 2D versus 3D CRT planning; hence, in high-case-load centres, 2D planning may be used. Follow-up at regular intervals with imaging may aid in earlier identification of failures with better salvage and improved survival.

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Authors and Affiliations

  1. Department of Radiation Oncology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, 517507, India

    Archana Prathipati, Swapna Jilla, B. V. Subramanian & Ravi krishna Madala

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  1. Archana Prathipati
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  2. Swapna Jilla
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  3. B. V. Subramanian
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  4. Ravi krishna Madala
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Correspondence to Swapna Jilla.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Retrospective study, adding ethical certificate as separate file.

Informed Consent

Informed consent was obtained from all individual participants included in the study before treatment in our hospital, and no individual identity was disclosed.

Appendix

Appendix

See Tables 10, 11, 12, 13.

Table 10 Multivariate analysis of prognostic factors on DFS
Full size table
Table 11 Multivariate analysis of prognostic factors on OS
Full size table
Table 12 Non-cancer-related causes of death
Full size table
Table 13 Second malignancies identified during follow-up
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Prathipati, A., Jilla, S., Subramanian, B.V. et al. Impact of Various Prognostic Factors on Overall Survival, Disease-Free Survival and Patterns of Failure in Carcinoma Cervix: A Tertiary Care Centre Experience from South India. Indian J Gynecol Oncolog 16, 11 (2018). https://doi.org/10.1007/s40944-018-0179-8

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  • DOI: https://doi.org/10.1007/s40944-018-0179-8

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