Abstract
<b>Objectives:</b> Cervical cancer (CC) epidemiology and natural history are often reported for an overall population; however, focusing on specific groups of patients (pts), such as those with locally advanced CC (LACC), may help to understand the unique risks. We conducted a systematic literature review (SLR) to create a global picture and identify gaps in the prevalence and natural history of LACC. <b>Methods:</b> Literature databases (2010-2020) were searched for English-language observational studies reporting prevalence, pt and disease characteristics, and risk factors for pts with stages IB2-IVA CC. The proportion of pts with LACC (prevalence) in studies of all stages of CC was calculated as follows: <i>1)</i> if stage reported as I/II/III/ IV, stage II/III were deemed LACC; <i>2)</i> if stage reported as <i>in situ</i>/local- ized/regional/distant, regional was deemed LACC per SEER staging; <i>3)</i> if stage reported as FIGO group, IB2-IVA were deemed LACC. For natural history, only characteristics/prognostic factors for overall survival (OS) reported in >7 studies are discussed. <b>Results:</b> Twenty-nine studies reported CC prevalence by disease stage, without population exclusions. Six of these studies reported a high proportion of CC pts with unknown stage: Gulf nations (25%), Trinidad & Tobago (26%), Jordan (28%), South Africa (29-42%), Morocco (36%), and Kenya (54%). For LACC prevalence, the interquartile range was 26-52% among pts with CC. Lower LACC prevalence was observed in North America versus Asia, Europe, and other regions, with Asia having the highest overall prevalence (Table). Thirty studies reported natural history data for LACC pts; 13 in Asia, seven Europe, six US, two Colombia, and two in Africa. Across countries, pts with LACC had a median age of 45-55y (26 studies), Charlson/Deyo comorbidity score of 0 or 1 (seven studies), and low hemoglobin level (seven studies). Stage II was most frequent in Europe, and LACC was split between II and III in the US and Asia (Table). Lymph node (LN) involvement varied, with no clear regional trend (Table). Most studies on prognostic factors of OS for LACC pts found stage III/IVA (8/13 studies), tumor size >4-6 cm (6/9 studies), absence of chemo/ brachytherapy (6/9 studies), and positive LN (6/8 studies) predicted worse OS; age (8/11 studies) was not predictive of OS, with no consensus on histology. <b>Conclusions:</b> Median LACC prevalence was 27-47% among pts with CC globally—this is likely underestimated due to our conservative approach to calculating LACC, as well as limitations within the studies comprising this SLR (e.g., inconsistent use of staging, pts with unknown stage, etc.). Characteristics of pts with LACC were similar globally, but the stage and LN involvement varied regionally. The consensus was that stage, tumor size, treatment type, and LN status were prognostic factors for OS. Continued research and individual local assessment will be critical in aptly identifying LACC pts and their clinical profiles for optimal treatment.
Published Version
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