Prognostic Factors in Cervical Cancer: A Hospital-based Retrospective Study from Visakhapatnam City, Andhra Pradesh

Cancer of uterine cervix is the second most common cause of cancer related deaths among women. The purpose of this retrospective study was to determine the survival rates of cervical cancer patients, to evaluate the prognostic significance of clinicopathological factors by univariate and multivariate analysis, and to compare the incidence and survival rates of cervical cancer patients. The mean length of the follow-up period was 29.5 months from the date of surgery or radiotherapy, with a follow up period of 60 months. The overall survival is 83.3% and disease free survival is 76.8%. It was found by Cox Regression Analysis (CRA) that only clinical stage (p<0.001) is the independent prognostic factor. In multivariate analysis, patients with cervical adenocarcinoma had a worse prognosis than patients with squamous cell carcinoma after correction for confounders such as age, stage and histological types. In univariate analysis the patients with age group of above 50 years, advanced stage and treatment with radiotherapy alone emerged as independent prognostic factors with a significant p value (p < 0.05). and high-risk HPVs include types 16, 18, 31 and 33. Types 16 and 18 are mostly found in cervical cancer and are transmitted by sexual contact (Rughooputh et al. 2007). While HPV vaccines have been launched recently to prevent infection by the two major types of HPV causing cervical cancer, prevention will still need to rely on early detection of cervical cancer precursors by screening for several years before the full impact from affordable and efficient immunization programmes can be felt. Cervical cancer deaths need to be prevented urgently in the developing world to reduce disparities and improve women’s health. In our study the clinicopathological factors age, stage, grade, pathology, histology and treatment were considered for prognosis. The effect of young age on survival in cervical cancer is not fully known, although evidence has suggested that it is a poor prognostic factor and that young patients should therefore be treated differently from older patients (Clive et al. 1988). The incidence and mortality levels differ significantly within every stage (Ruta Grigiene et al. 2007). The clinical stage was very important in relation to prognosis. The prognosis depends on the stage of the disease at the time of diagnosis. The 5-year survival rate for all stages of cervical cancer combined is approximately 70%. As to survival, there was no difference between Address for correspondence: K. Geetha Kumari Department of Human Genetics, Andhra University Visakhapatnam 530 003, Andhra Pradesh, India E-mail: [email protected] 100 K. GEETHA KUMARI, G. SUDHAKAR, M. RAMESH, V. L. KALPANA AND G. PADDAIAH adenocarcinoma and squamous cell carcinoma when compared in all patients, but adenocarcinoma had a worse prognosis than squamous cell carcinoma when surgery was employed (Nippon 1989). The treatment of choice for invasive cervical cancer in the initial stages is radiotherapy or radical hysterectomy with pelvic bilateral lymphadenectomy. Surgery is preferable among young patients because of the possibilities of ovary preservation, hormonal function maintenance and better sexual performance (Sao Paulo 2009). MATERIALS AND METHODS This is a retrospective analytic study of 552 cervical cancer patients treated in Lions Cancer Hospital, Visakhapatnam between January 2001 to December 2003. These cases were evaluated over a period of five years from January 2001 to December 2008. Treatment records of patients under active follow up were abstracted. Regular follow–up investigations were performed at department of Gynecology, Lion’s Cancer Hospital at 3 months intervals during the first 3 years following treatment and twice yearly thereafter. The following variables were analyzed: age group (21-80 years), pathological grade ( I-III ) and stage ( IA, IB, IIA, IIB, IIIB, IVA, IVB ), pathology (squamous or adenocarcinoma ) histological type ( LCK-Large cell keratinizing OR LCNK-Large cell non-keratinizing ) date of primary diagnosis, the type of primary treatment ( radiotherapy, chemotherapy, both or none ) and date of treatment completion, date and sites of recurrences, treatment for recurrence, the followup data , death date and date of last follow-up visit were recorded. The surgical pathological staging standard issued by the International Federation of Gynecology and Obstetrics (FIGO) in 1994 was used. Statistical analysis of the data was carried out by the SPSS (version 13.0). Descriptive statistics were used for demographic data and summarized as mean with standard deviation or frequency with percentage. The survival rate was analyzed with the Kaplan-Meier method. Survival data between groups were compared with the Logrank test for univariate analysis and Cox regression analysis for multivariate analysis. The 95% confidence interval (CI) was calculated for the risk ratios for each of the significant prognosticators. A p-value <0.05 was considered to indicate statistical significance.