Sixteen years of systemic therapy for advanced cervical cancer in Armenia: Treatment patterns, disease burden, and survival outcomes from the National Oncology Centre (2008–2024)
Jul 2026· South Asian Journal of Cancer· Vol 15, pp. 344-349· 0 citations· 11 references
TL;DR
Despite late-stage presentation typical of low- and middle-income countries, survival outcomes were broadly consistent with international real-world data and highlights the urgent need for improved screening programmes.
Abstract
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.
Purpose of the study
. To evaluate treatment outcomes in patients with stage III–IV colon cancer residing in the Southern Federal District of the Russian Federation.
Patients and method
s. A retrospective analysis was performed of the medical records of 200 patients with stage III–IV colon cancer who underwent treatment and follow-up at the National Medical Research Centre for Oncology between 2019 and 2024. Overall survival (OS) was assessed, as well as its association with sex, disease stage, primary tumor location, KRAS, NRAS, and BRAF mutation status, tumor microsatellite instability (MSI) status, and antitumor treatment strategy.
Results
. The median follow-up from the time of presentation to the National Medical Research Centre for Oncology was 1.4 years. The 5‑year OS rate was 31 %, with a median overall survival of 3.4 years. The 5‑year OS rate was significantly associated with disease stage, reaching 46 % in patients with stage III disease and 18 % in those with stage IV disease (p = 0.00005). The presence of KRAS mutations (3‑year OS: 53 % in the wild-type group vs. 28 % in the mutant group), BRAF mutations (42.5 % vs. 18 %, respectively), and MSI status (67 % for MSI tumors vs. 42.5 % for microsatellite-stable [MSS] tumors) significantly influenced survival outcomes. Among patients with stage IV disease, survival was also associated with the type of targeted therapy administered. Improved survival was observed in patients receiving combined inhibition of vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR) compared with VEGF inhibitor-based therapy alone. The 3‑year OS rate was 66 % (median OS, 4.1 years) in the combined EGFR/VEGF inhibition group versus 31 % (median OS, 2.1 years) in the VEGF inhibitor group.
Conclusion
. Nearly half of all colon cancer cases (47.6 %) were diagnosed at advanced stages, which are associated with an unfavorable prognosis, particularly in tumors harboring pathogenic mutations and exhibiting a microsatellite-stable phenotype. These findings underscore the importance of genetically and epigenetically guided therapeutic approaches aimed at identifying novel therapeutic targets and developing more effective treatment strategies.
O. Kit, I. Mironenko, E. Dzhenkova et al.· South Russian Journal of Can...· 0 citations
Background: Renal cell carcinoma (RCC) is a biologically heterogeneous malignancy with variable clinical behaviour and survival outcomes. Real-world data from low-and middle-income countries remain limited, particularly regarding stage-specific treatment patterns and survival outcomes. Methods: This retrospective cohort study included adult patients diagnosed with RCC and treated at the Clinical Oncology Department, Ain Shams University Hospitals, between January 2018 and December 2023. Patients were analysed as two pre-specified cohorts: (1) localised disease (Stage I–III) undergoing curative-intent surgery ( n = 45) and (2) metastatic disease (Stage IV) receiving systemic therapy ( n = 34). Survival outcomes were analysed using the Kaplan–Meier (KM) method and reported as medians with inter-quartile ranges (IQRs). Results: A total of 79 patients were included (50 male, 63.3%; median age 57 years, IQR 50–66). In the localised cohort ( n = 45), 43 underwent curative-intent surgery; disease recurrence occurred in 17 (39.5%). The 12-month disease-free survival (DFS) was 78.2%, and the 36-month DFS was 64.1%; median DFS was not reached within the observation period. In the metastatic cohort ( n = 34), sunitinib was the predominant first-line agent; the KM estimated median progression-free survival (PFS) on sunitinib was 16 months (IQR 6–36), with a 6-month PFS rate of 75.4% and a 12-month PFS rate of 58.0%. The KM estimated median overall survival (OS) for Stage IV patients was 43 months from diagnosis. Disease recurrence and progression were significantly associated with inferior OS ( p = 0.003 and p = 0.01, respectively). Conclusion: Surgical resection remains the cornerstone of curative management. In the metastatic setting, sunitinib provided meaningful and durable disease control (median PFS 16 months; KM median OS 43 months) despite restricted immunotherapy access. High-risk pathological features identified in 33% of the localised cohort highlight an unmet need for adjuvant immunotherapy in resource-limited settings.
Zizit Hamdi Mohammed El-Shahawi, S. S. Ismail, L. Ahmed et al.· ecancermedicalscience· 0 citations
Aims: Older adults are underrepresented in adjuvant colon cancer trials, leaving uncertainty regarding oxaliplatin benefit and optimal treatment duration. This study evaluated the associations of adjuvant chemotherapy patterns, treatment duration, and clinicopathological factors with overall survival (OS) and disease-free survival (DFS) in patients aged ≥70 years with resected stage II-III colon cancer.Methods: This single-center retrospective study included patients aged ≥70 years with resected stage II-III colon cancer. Survival outcomes were analyzed using Kaplan-Meier methods and Cox regression analyses.Results: Forty-six patients were included; the mean age was 74.39±4.48 years, and 56.5% were male. Overall, 56.5% received oxaliplatin-containing chemotherapy, and 71.7% completed six months of treatment. Disease progression occurred in 41.3% of patients, and 28.3% died. Estimated mean OS and DFS were 100.9 months and 84.2 months, respectively. Although six-month chemotherapy was associated with OS and showed a borderline association with DFS in reduced exploratory Cox models, these associations were attenuated and were no longer statistically significant in the 6-month landmark sensitivity analysis. Oxaliplatin-containing chemotherapy was not significantly associated with OS or DFS in the overall cohort. Conclusion: In this retrospective single-center cohort of patients aged ≥70 years with resected stage II–III colon cancer, sixmonth adjuvant chemotherapy was associated with longer survival in conventional analyses but was no longer statistically significant in the 6-month landmark sensitivity analyses. Therefore, this finding should be interpreted cautiously because of potential immortal time bias, survivor selection, treatment-selection bias, and residual confounding. Oxaliplatin-containing chemotherapy was not significantly associated with OS or DFS in the overall cohort. These findings should be considered hypothesis-generating and should not be interpreted as causal evidence regarding optimal treatment duration or oxaliplatin benefit in older adults.
Zekeriya Hannarici, A. Turhan, M. E. Büyükbayram et al.· Journal of Medicine and Pall...· 0 citations
The shift towards more selective use of preoperative radiotherapy in rectal cancer raises concern that locoregional control may be compromised. The aim was to evaluate whether changes in staging, risk stratification, and treatment across three national guideline periods were associated with differences in oncological outcomes in patients with clinical stage I–III rectal cancer treated with curative intent.
2035 patients from Dalarna, Gävleborg, and Uppsala County with clinical stage I-III rectal cancer were included. Data were obtained from the Swedish Colorectal Cancer Registry and supplemented by review of electronic patient records. Logistic regression with guideline period modelled as an ordinal variable was used to assess differences in treatment over time. Associations between guideline period and oncological outcomes were analysed using unadjusted and adjusted Cox and Fine-Gray models.
The proportion of patients staged as cN0 increased over time (OR per period 1.40, 95% c.i. 1.25–1.56), whereas the proportion of patients with cN2 decreased (OR 0.67, 95% c.i. 0.59–0.76). Direct surgery increased (26, 33, and 43%), while overall preoperative treatment (44, 40, and 31%) and short-course radiotherapy (35, 27, 12%) decreased over time.
Locoregional recurrence was 3.1% at 5 years and did not differ between guideline periods. No differences were observed in distant metastasis, overall survival, or relative survival after adjustment, although unadjusted analyses suggested lower distant metastasis rates in the most recent period.
Reduced use of preoperative radiotherapy was not associated with impaired oncological outcomes. The findings support a more selective radiotherapy use while maintaining oncological safety and reducing treatment-related morbidity.
S. Doroudian, E. Osterman, B. Glimelius· British Journal of Surgery· 0 citations
Background and Aims
Prostate cancer (PC) is a common male malignancy, and it is often diagnosed at advanced stages, particularly in developing countries, largely due to underdeveloped healthcare systems. Resource-limited care, such as bilateral orchidectomy for symptomatic illness, is an economically feasible therapeutic option that may enhance patient condition and survival in a low-resource situation. This study aims to assess the status of PC care and treatment outcomes in eastern Sudan.
Methods
A retrospective hospital-based study was conducted at the East Oncology Centre (EOC), Gadarif State, eastern Sudan, including all patients diagnosed with PC between May 2016 and December 2023. Relevant demographic, clinical, pathological, treatment, and outcome data were retrieved from patients' medical records.
Results
A total of 231 patients with PC, with a mean age of 70.9 years (± SD 10), all of whom were Sudanese from different ethnic groups, were included in the study. Most patients (86.6%; n = 200) presented with lower urinary tract symptoms, and only 15.6% had a family history of PC. Most of the patients (62.34%, n = 144) had prostate-specific antigen (PSA) levels ranging from 21 to 100 ng/mL; histopathology revealed adenocarcinoma of the prostate with a Gleason score of 8 or more in 60.6% (n = 140). Bone scan results were positive in 50.2% of cases, and 88.3% (n = 204) received hormonal treatment as the primary modality for cancer control. The mortality data indicate that 24.7% (n = 57) of patients had died.
Conclusions
This study highlights the suboptimal care for PC in eastern Sudan, where most patients present with late-stage disease, probably due to resource limitations. Addressing late-stage PC requires opportunistic digital rectal examination screening, targeted PSA testing, and increased awareness. Improved outcomes rely on specialist training, standardised care protocols, and the expansion of radiation facilities.
Mosab A. A. Alzubier, E. A. Eltahir, Hind Mohi Aldin Abd Allah et al.· Advances in Urology· 0 citations
Background For early-stage cervical cancer, surgery constitutes the standard therapeutic approach. Whether adjuvant radiotherapy and chemotherapy should be administered to patients with intermediate- or high-risk pathological characteristics continues to generate debate. Controversy persists regarding the ideal postoperative adjuvant treatment approach for this patient population. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study compared survival outcomes among early-stage cervical cancer patients managed with observation, postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). Methods Patients with stage I–II cervical cancer who underwent surgical treatment from 2004 to 2020 were identified through the SEER database. Patients were classified into three cohorts based on their postoperative management: observation, PORT, and POCRT. Overall survival (OS) and cancer-specific survival (CSS) were assessed through Cox proportional hazards regression, competing risk modeling, Kaplan-Meier survival curves, and subgroup analyses. Results Among 13,687 eligible patients, 9,868 underwent postoperative observation, 1,237 received PORT, and 2,582 received POCRT. In the unmatched overall cohort, patients receiving adjuvant therapy had higher mortality rates and higher-risk baseline profiles. Stratified analysis demonstrated that postoperative observation was associated with better survival than PORT and POCRT in stage I patients (P<0.001), whereas POCRT was associated with better survival compared with observation and PORT in stage II patients (P=0.04). Subgroup analyses suggested associations between postoperative adjuvant therapy and better survival among patients with T2 disease, N1 status, multiple primary malignancies (≥2), or age ≥60 years. Conclusions For patients with early-stage cervical cancer, the decision regarding PORT and chemotherapy should remain guided by current guideline-based risk stratification. Our findings suggest that tumor (T) stage, node (N) stage, multiple primary malignancies, and age warrant further investigation as potential effect modifiers.
Chang Weng, Yan Wang, Wen-B. Chen et al.· Translational Cancer Researc...· 0 citations
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