Long-Term Survival Rates and Prognostic Factors of Cervix Cancer Treated by Different Modalities

Objective: To assess the overall survival (OS) and prognostic factors in patients with cervix cancer treated by different modalities. Material and Methods: The authors studied a cohort of patients with cervix cancer International Federation of Gynecology and Obstetrics stage I-IVa treated in the last 15 years. Patients were treated with surgery followed by radiotherapy (S+RT), or surgery plus chemoradiation (S+CRT), or radiotherapy alone (RT), or chemoradiation alone (CRT). Univariate and multivariate analyses were conducted to identify significant prognostic factors (P<0.05). Results: A total of 380 patients with cervix cancer were included. The treatment groups were S+CRT (37.5%), CRT (33%), RT (20%), and S+RT (9.5%). The median follow-up was 7.6 years, the OS in 5 and 10 years according to the treatment groups was 43.3%, and 17.3% for S+RT, 47.8% and 41.9% for S+CRT, 40.7% and 27.9% for CRT, and 29.1% and 19.4% for RT (P<0.0001). The stage IIb-IVa, age 60 years or older, RT, and 2DRT were significant factors in the univariate and multivariate analyses. In stage I-IIa, no significant difference was found among the treatment groups (P=0.907). In stage IIb-IVa, a significant difference was observed (P=0.0001). CRT versus RT had significance, and no difference between S+RT versus S+CRT, and S+CRT versus CRT was seen for stage IIb-IVa. Conclusions: In a long-term follow-up, no significant difference among the treatment modalities was found for early disease. For stage IIb-IVa, significant differences were observed, with RT having the worst survival, and CRT similar to S+CRT. These outcomes show that tumor and patients characteristics can be used to decide the best treatment option outside a clinical trial.