Epidemiology and outcome of cervical cancer in national institute of Morocco

Abstract

Background: On behalf of the medical staff of the National Institute of Oncology of Rabat, we conducted a retrospective study to report epidemiology and 5-year outcomes of cervical carcinoma in Moroccan women.

Methods: We reviewed all women diagnosed with invasive cervical carcinoma in our institute between January 2006 and December 2006. Outcomes and prognoses are analyzed in patients who received at least one treatment.

Results: The analysis included 646 women. Median age was 50 years (23-85 years). Bleeding was the most frequent symptom (95 %). The most predominant histology was squamous cell carcinoma (94 %). The majority of patients were diagnosed at locally advanced stages (88 %). Among patients who received treatment (n = 550), the management was based on concurrent chemoradiotherapy in 69.7 % of cases. The median duration of follow-up was 60 months (range 2-78 months). Overall survival, progression free survival, and locoregional recurrence free survival were 63.2, 60.7 and 79.1 % respectively. Significant poor prognostic factors in univariate analysis included stage, tumor size, lymph node involvement, anemia and absence of response to radiotherapy. The prognostic significance of response to radiotherapy and stage were retained in multivariate analysis.

Conclusion: Cervical cancer in our Institute is diagnosed at locally advanced stages. Two third of patients were treated by concurrent chemoradiotherapy. Outcome of Moroccan patients are comparable to that of western countries. Significant prognostic factors were stage, tumor size, lymph node involvement, anemia, and response to radiotherapy. The way to reduce the global burden of cervical cancer in our country continues to be the development of vaccination and screening programs.

Keywords: Cervical cancer; Epidemiology; Outcomes; Treatments.

Fig. 1

Treatments modalities

Fig. 2

Survival curves. Figure 1a: Overall survival; Fig. 1b: Locoregional recurrence free survival; Fig. 1c: Progression free survival

Fig. 3

Prognostic factors. Overall survival, Loco regional recurrence free survival, and progression free survival curves according to prognostic factors. (4a, 4b, 4c): Tumor size; (4d, 4e, 4f): Clinical stage; (4 g, 4 h, 4i): Lymph node involvement; (4j, 4 k, 4 l): Hemoglobin level less than 12 g/dl during radiotherapy; (3 M, 3 N, 3O): Tumor response to radiotherapy