Abstract
BackgroundThe aim of our study was to investigate and evaluate the prognostic value of and correlations between preclinical and clinical factors such as the stage of the disease, blood Hb level before treatment, size of cervix and lymph nodes evaluated by CT, age, dose of irradiation and duration of radiotherapy related to overall survival, disease-free survival, local control and metastases-free survival in cervical cancer patients receiving radiotherapy alone.Methods162 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIA-IIIB cervical carcinoma treated with irradiation were analysed. Univariate and multivariate analyses using the Cox regression model were performed to determine statistical significance of some tumor-related factors.ResultsThe Hb level before treatment showed significant influence on overall survival (p = 0.001), desease free survival (p = 0.040) and local control (p = 0.038). The lymph node status (>10 mm) assessed on CT had impact on overall survival (p = 0,030) and local control (p = 0,036). The dose at point A had impact on disease free survival (p = 0,028) and local control (p = 0,021) and the radiotherapy duration had showed significant influence on overall survival (p = 0,045), disease free survival (p = 0,006) and local control (p = 0,033).ConclusionAnemia is a significant and independent prognostic factor of overall survival, disease-free survival and local control in cervical cancer patients treated with irradiation. The size of lymph nodes in CT is an independent prognostic factor for overall survival and local control in cervical cancer patients. The size of cervix uteri evaluated by CT has no prognostic significance in cervical cancer patients treated with radiotherapy. The prognostic value of FIGO stage of cervical cancer is influenced by other factors, analyzed in this study and is not an independent prognostic factor.
Highlights
The aim of our study was to investigate and evaluate the prognostic value of and correlations between preclinical and clinical factors such as the stage of the disease, blood Hb level before treatment, size of cervix and lymph nodes evaluated by CT, age, dose of irradiation and duration of radiotherapy related to overall survival, disease-free survival, local control and metastases-free survival in cervical cancer patients receiving radiotherapy alone
The Kaplan-Meier method was used to assess the importance of factors we have selected influencing the overall survival, disease-free survival, local control and distant-metastases-free survival of patients with cervical cancer (Table 1)
There were no significant effect of patient age on overall survival (OS): patients < 50 had a 3-year OS of 64% (95%CI 51.3%–74.3%), 78,8% (95%CI 65.6%–87.4%) for age 50–64 and 76.3% (95%CI 54.2%–88.8%) for > 64 years (p = 0.2960); and on disease free survival (DFS): patients < 50 had a 3-year DFS of 70.7% (95%CI 58.1%–80.13%), 76.5% (95%CI 62.8%–85.8%) for age 50–64 and 79.8% (95%CI 57.4%–91.2%) for > 64 years (p = 0.4513)
Summary
The aim of our study was to investigate and evaluate the prognostic value of and correlations between preclinical and clinical factors such as the stage of the disease, blood Hb level before treatment, size of cervix and lymph nodes evaluated by CT, age, dose of irradiation and duration of radiotherapy related to overall survival, disease-free survival, local control and metastases-free survival in cervical cancer patients receiving radiotherapy alone. In 2004, 569 new cases of cervical cancer were diagnosed in Lithuania. This number is higher (by about 100 cases) than that observed in 2003. The lifetime risk of cervical cancer in Lithuania is 1 of 65 women. Most often cervical cancer develops in women aged 30 to 59 years, i.e. when they are most able-bodied. Advanced cervical cancer (stages III and IV) was diagnosed in 46% of patients [1]. Radiotherapy was usually used in stages II-IV cervical cancer. About 60% of patients with cervical cancer in Lithuania used to undergo radiotherapy. The golden standard in advanced cervical cancer patients treatment is chemoradiotherapy, but this treatment option is more toxic and may be not everyone needs such aggressive treatment. It is very important to define the factors that influence results in radiotherapy
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