J Gynecol Oncol.  2015 Oct;26(4):262-269. 10.3802/jgo.2015.26.4.262.

Longer waiting times for early stage cervical cancer patients undergoing radical hysterectomy are associated with diminished long-term overall survival

• Nanthamongkolkul K
• Hanprasertpong J

• KMID: 2345916
• DOI: http://doi.org/10.3802/jgo.2015.26.4.262

Abstract

OBJECTIVE
The aim of this study was to evaluate the impact of surgical waiting time on clinical outcome in early stage cervical cancer.
METHODS
The cohort consisted of 441 patients diagnosed with stages IA2-IB1cervical cancer who underwent radical hysterectomy and pelvic node dissection. The patients were divided into two groups based on surgical waiting time. The associations between waiting time and other potential prognostic factors with clinical outcome were evaluated.
RESULTS
The median surgical waiting time was 43 days. Deep stromal invasion (hazard ratio [HR], 2.5; 95% confidence interval [CI], 1.4 to 4.6; p=0.003) and lymph node metastasis (HR, 2.9; 95% CI, 1.3 to 6.7; p=0.026) were identified as independent prognostic factors for recurrence-free survival while no prognostic significance of surgical waiting time was found (p=0.677). On multivariate analysis of overall survival (OS), only deep stromal invasion (HR, 2.6; 95% CI, 1.3 to 5.0; p=0.009) and lymph node metastasis (HR, 3.6; 95% CI, 1.5 to 8.6; p=0.009) were identified as independent prognostic factors for OS. Although OS showed no significant difference between short (< or =8 weeks) and long (>8 weeks) waiting times, multivariate analysis of OS with time-varying effects revealed that a waiting time longer than 8 weeks was associated with poorer long-term survival (after 5 years; HR, 3.4; 95% CI, 1.3 to 9.2; p=0.021).
CONCLUSION
A longer surgical waiting time was associated with diminished long-term OS of early stage cervical cancer patients.

Keyword

Prognosis; Radical Hysterectomy; Uterine Cervical Neoplasms; Waiting Time

MeSH Terms

Adult
Aged
Disease-Free Survival
Female
Humans
Hysterectomy/*methods/mortality/statistics & numerical data
Middle Aged
Neoplasm Recurrence, Local/etiology/mortality
Prognosis
Retrospective Studies
*Time-to-Treatment
Uterine Cervical Neoplasms/mortality/pathology/*surgery

Figure

• 

  Fig. 1 (A) Recurrence-free survival (RFS) among cervical patients assigned to waiting times of fewer than or equal to and more than 4 weeks. (B) RFS among cervical patients assigned to waiting times of fewer than or equal to, and more than 8 weeks.

• 

  Fig. 2 (A) Overall survival (OS) among cervical patients assigned to waiting times of fewer than or equal to, and more than 4 weeks. (B) OS among cervical patients assigned to waiting times of fewer than or equal to, and more than 8 weeks.

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