DFS in cervical cancer is strongly influenced by tumor burden and locoregional spread, and the early decline in survival highlights the need for intensive follow-up during the first two years post-treatment.
Abstract
Introduction Cervical cancer remains a major public health concern in India, with a substantial burden of late-stage diagnosis and limited survival data from tertiary care settings. Disease-free survival (DFS) is a key indicator of treatment effectiveness and recurrence risk, yet evidence on its determinants in Indian populations remains limited. This study aimed to assess DFS pattern and identify prognostic factors among cervical cancer patients treated at a tertiary care center in India. Data and methods A retrospective–prospective cohort study was conducted at Sir Sunderlal Hospital, Banaras Hindu University, Varanasi. The study included 587 cervical cancer patients diagnosed between 2011 and 2021, with follow-up until February 2025. Disease-free survival was defined as the time from first follow-up after treatment completion to recurrence. Kaplan–Meier methods, log-rank tests, and Cox proportional hazards models with time-varying covariates were used to estimate survival and identify predictors. Results The median follow-up duration was 23.4 months (IQR: 10.2–52.6). Most patients were aged ≤50 years (51.8%), from rural areas (68.5%), and presented with advanced disease (FIGO stage II: 36.3%; stage III: 45.8%). Squamous cell carcinoma accounted for 91.8% of cases, and 76.0% had tumor size ≥4 cm. Kaplan–Meier analysis showed a sharp decline in DFS during early follow-up, indicating a higher risk of recurrence in the initial years. Significant differences in DFS were observed by age (p=0.002), tumor size (p=0.005), vaginal involvement (p=0.011), lymph node involvement (p=0.012), and addiction status (p=0.023). In multivariable analysis, age ≤50 years (AHR = 1.64; 95% CI: 1.16–2.34), tumor size ≥4 cm (AHR = 2.98; 95% CI: 1.44–6.15), and vaginal involvement (AHR = 1.56; 95% CI: 1.06–2.29) were independently associated with poorer DFS. Tumor size also showed a significant time-varying effect (HR = 0.97, p=0.010). Conclusion DFS in cervical cancer is strongly influenced by tumor burden and locoregional spread. The early decline in survival highlights the need for intensive follow-up during the first two years post-treatment. Targeted interventions focusing on early detection and risk-stratified management are essential to improve outcomes in resource-limited settings.
Introduction: non-small cell lung cancer accounts for most lung cancer-related deaths worldwide. Although tumour-node-metastasis staging remains the cornerstone of prognostication, histological subtype and tumour differentiation may provide additional prognostic value, particularly in low- and middle-income countries where advanced molecular testing is limited. Evidence on these factors in Ethiopia is scarce. Methods: an institution-based retrospective cohort study was conducted among 202 adult patients who received follow-up care at three specialised hospitals in Ethiopia between January 2020 and January 2025. Data were extracted from medical records and supplemented with telephone follow-up to ascertain survival outcomes. Overall survival was estimated using the Kaplan-Meier method, and Cox proportional hazards regression models were applied to identify independent predictors of mortality, with statistical significance set at p < 0.05. Results: the median overall survival was 10 months. Patients with squamous cell carcinoma had significantly better survival than those with non-squamous cell carcinoma (log-rank p = 0.020). Survival also differed significantly by histological differentiation (log-rank p = 0.001). In multivariate analysis, advanced primary tumour stage, contralateral nodal involvement, distant metastasis, non-squamous histology, moderately or poorly differentiated /undifferentiated tumours, and poor performance status were independently associated with worse survival. Similarly, Patients aged 40-59 years and ≥ 60 years had significantly lower hazards of death compared with patients aged under 40 years. Conclusion: histological subtype and tumour differentiation are independent predictors of survival among NSCLC patients in Ethiopia, beyond conventional TNM staging. These findings provide context-specific evidence from an Ethiopian cohort, where advanced molecular profiling is limited, and highlight the prognostic value of routinely available histopathological features in guiding clinical decision-making in resource-constrained settings.
Binalfew Tsehay, M. Afework, Wondwossen Ergete et al.· The Pan African Medical Jour...· 0 citations
It was found that prolonged DTIs to be significantly associated with poorer survival, but cautious interpretation of the results is needed given the potential impact of the waiting time paradox.
M. Jalink, W. King, Christopher M. Booth et al.· Cancer Epidemiology· 0 citations
Cervical cancer disproportionately affects low- and middle-income countries, yet real-world treatment data from many regions remain scarce. We aimed to describe treatment patterns, disease burden, and survival outcomes in patients with advanced cervical cancer treated at Armenia's national referral centre.
We conducted a retrospective cohort study of consecutive patients with advanced cervical cancer who received paclitaxel-platinum chemotherapy at the national oncology centre between January 2008 and August 2024. Treatment response was assessed clinically and radiologically after the first chemotherapy course. Overall survival was estimated using the Kaplan-Meier method with 95% confidence intervals. Temporal trends were examined across three treatment eras.
A total of 159 patients were included (mean age 51.7 ± 10.2 years). The majority presented with advanced disease: 87.9% had International Federation of Gynaecology and Obstetrics (FIGO) stage III–IV, and 57.2% had distant metastases. Treatment regimens included paclitaxel-carboplatin (63.5%) and paclitaxel-cisplatin (35.2%); 38.4% received bevacizumab. The overall response rate was 48.4%, and the disease control rate was 64.2%. Median overall survival was 36.0 months (95% CI: 26.0–56.0). Bevacizumab use varied across eras (35.7% in 2008–2014, 20.0% in 2015–2018, and 53.2% in 2019–2024), whilst stage III–IV presentation increased from 78.6% in 2008–2014 to 91.0% in 2019–2024.
Despite late-stage presentation typical of low- and middle-income countries, survival outcomes were broadly consistent with international real-world data. The rising proportion of advanced-stage disease highlights the urgent need for improved screening programmes.
A. Tadevosyan, Gagik Jilavyan, Evelina Bakhshinyan et al.· South Asian Journal of Cance...· 0 citations
A clinical model incorporating age (≥65 years), T stage (T3/T4), N stage (N2/N3), and chemotherapy (no) was developed to predict inferior OS in early-stage MedBC.
Y. Tan, X. Tian, Q. Li et al.· Hong Kong medical journal =...· 0 citations
Background Time to treatment initiation (TTI) following cancer detection is a critical component of effective cancer control. In low-resource and rural settings, delays in TTI often reflect health system constraints and may undermine the survival benefits of screening programmes. However, evidence on the association between TTI and long-term survival among screening-positive patients with upper gastrointestinal cancer (UGC) in China is unknown. Methods This retrospective cohort study included 265 screening-positive UGC patients identified from a population-based screening programme conducted between 2014 and 2015 in rural China (total screened population = 13,255). Time to treatment initiation was defined as the interval between confirmed diagnosis and initiation of treatment. Patients were categorised into ≤30 days, >30 days, and untreated groups. The primary outcome was 10-year overall survival (OS). Cox proportional hazards models were used to estimate hazard ratios (HRs), adjusting for demographic, socioeconomic, and clinical variables. Results The median TTI was 55 days. Patients with TTI≤30 days had significantly higher 10-year OS (90.39%) compared with those with TTI>30 days and untreated patients. After adjustment, delayed treatment (>30 days) was associated with worse OS (HR = 2.50; 95% CI = 1.29–4.82) and cancer-specific survival (HR = 2.41; 95% CI = 1.21–4.79). Factors associated with delayed treatment included male, non-normal BMI, and earlier-stage lesions, indicating socioeconomic and structural barriers to timely treatment. Conclusions Delays in treatment initiation represent a critical health system bottleneck that significantly compromises long-term survival among screening-detected UGC patients. A TTI threshold of 30 days may serve as a pragmatic quality-of-care indicator. Strengthening linkage-to-care pathways and addressing socioeconomic barriers are essential to maximise the effectiveness of cancer screening programmes in low-resource settings.
Ruyue Liu, Lian-Lian Wu, Chengxu Long et al.· Journal of Global Health· 0 citations
Background Distant lymph node metastasis (DLM) is rare in head and neck cancer (HNC), occurring in only 0.76% of cases, underscoring the importance of understanding its clinical behavior. However, population-based data on the incidence, predictors, and prognostic implications of DLM relative to other metastatic patterns remain limited. This study aimed to determine the incidence of DLM at diagnosis, identify its independent predictors, and evaluate the impact of DLM and its treatment on survival in a population-based cohort of patients with HNC. Methods We performed a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database [2016–2022] and identified 42,908 patients with HNC. Multivariable logistic regression was used to determine factors associated with DLM at diagnosis. Overall survival (OS) was estimated using the Kaplan-Meier method. Cancer-specific mortality was assessed using a competing-risks analysis, while treatment effects within the DLM-positive cohort were studied using a 3-month landmark analysis to reduce immortal-time bias. Results DLM was present at diagnosis in 325 patients (0.76%). Independent prognostic factors were age 60 years or older, hypopharyngeal tumor primary site, advanced tumor (T) and node (N) stage, neuroendocrine carcinoma, and melanoma (all P<0.05). Model discrimination was good [area under the receiver operating characteristic curve (AUC) =0.835]. Patients with DLM had significantly shorter median OS than those without distant metastasis (8.0 vs. 78.0 months, P<0.001). Among the DLM-positive population, isolated nodal disease correlated with longer median OS than DLM in the presence of visceral spread (12.0 vs. 6.0 months; P<0.001), and this benefit persisted in a competing-risks analysis for cancer-specific death. In the landmark analysis, combined chemoradiotherapy remained associated with improved survival compared with no active treatment [adjusted hazard ratio (HR) =0.41, 95% confidence interval (CI): 0.26–0.63; P<0.001]. Conclusions These findings suggest that subclassifying metastatic disease could enhance risk stratification and guide more personalized treatment strategies.
Jian-Lin Yue, Da-Yu Liu, Rui-Jie Sun et al.· Translational Cancer Researc...· 0 citations
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