OBJECTIVE: To evaluate the relationship between type 2 diabetes mellitus (DM) and oncological outcomes in early stage cervical cancer patients who underwent radical surgical resection. METHODS: Patients with early stage cervical cancer diagnosed between 2001 and 2014 were retrospectively enrolled. We assessed the outcomes of 402 non-DM and 42 DM patients with cervical cancer. We tested the prognostic value of DM via Cox proportional hazard modeling. RESULTS: Patients with DM were more likely to be older and overweight. In the DM group, 20 and 22 patients were and were not taking metformin, respectively. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) rate for the whole study population were 88.49% and 96.34%, respectively. In the DM group, there was no evidence that metformin affected the RFS (p=0.553) or the OS (p=0.429). In multivariate analysis, age (p=0.007), histology (p=0.006), and deep stromal invasion (p=0.007) were independent adverse prognostic factors for RFS. There was a borderline significant association of increased RFS with DM (p=0.051). However, a time-varying-effect Cox model revealed that the DM was associated with a worse RFS (hazard ratio, 11.15; 95% CI, 2.00 to 62.08, p=0.022) after 5 years. DM (p=0.008), age (p=0.009), and node status (p=0.001) were the only 3 independent prognostic factors for OS. CONCLUSION: Early stage cervical cancer patients with type 2 DM have a poorer oncological outcome than patients without DM.
Adult ; Age Factors ; Diabetes Mellitus, Type 2/*complications/drug therapy ; Female ; Humans ; Hypoglycemic Agents/therapeutic use ; *Hysterectomy ; Metformin/therapeutic use ; Middle Aged ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Survival Analysis ; Uterine Cervical Neoplasms/*complications/diagnosis/surgery

Objective: To develop a nomogram for predicting 3-year overall survival (OS) and outcomes of surgically staged patients with uterine carcinosarcomas (UCS). Methods: This retrospective study analyzed the clinicopathological characteristics, treatment data, and oncological outcomes of 69 patients diagnosed with UCS between January 2002 and September 2018. Significant prognostic factors for OS were identified and integrated to develop a nomogram. Concordance probability (CP) was used as a precision measure. The model was internally validated using bootstrapping samples to correct overfitting. Results: The median follow-up time was 19.4 months (range, 0.77-106.13 months). The 3-year OS was 41.8% (95% confidence interval [CI], 29.9-58.3%). The International Federation of Gynecology and Obstetrics (FIGO) stage and adjuvant chemotherapy were independent factors for OS. The CP of the nomogram integrating with body mass index (BMI), FIGO stage, and adjuvant chemotherapy was 0.72 (95% CI, 0.70-0.75). In addition, the calibration curves for the probability of 3-year OS demonstrated good agreement between the nomogram-predicted and observed data. Conclusion The established nomogram using BMI, FIGO stage, and adjuvant chemotherapy accurately predicted the 3-year OS of patients with UCS. The nomogram was useful for patient counselling and deciding on follow-up strategies.

OBJECTIVE: To identify the characteristics of fear of cancer recurrence (FCR) in cervical cancer survivors (CCSs) and investigate the relationship of FCR with demographic and medical characteristics, level of quality of life (QOL), and psychological distress. We also aimed to determine the predictors of FCR. METHODS: The short version of the Fear of Progression Questionnaire (FoP-Q-SF), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-Cervical (FACT-Cx) questionnaire were administered to 699 CCSs who had complete treatment at Songklanagarind Hospital between 2006 and 2016. Analysis was performed to determine potential predictors associated with FCR. RESULTS: Among the 12 items of the FoP-Q-SF, the 3 greatest fears were 1) worrying about what would happen to their family; 2) being afraid of pain; and 3) fear of disease progression. The prevalences of anxiety and depression disorder were 20.46% and 9.44%, respectively. CCSs who had FCR at the 5th quintile were more likely to have medical co-morbidities, low FACT-Cx scores in all domains and a high HADS scores (anxiety and depression disorder). Multivariate analysis showed that only anxiety disorder (odds ratio [OR]=4.99; p<0.001) and low FACT-Cx score (total) (OR=6.14; p<0.001) were identified as independent predictors for FCR at the 5th quintile. CONCLUSION: FCR is an important problem in cervical cancer which should be addressed during post-treatment care. Only anxiety disorder and low QOL were independently associated with high FCR.
Anxiety ; Anxiety Disorders ; Depression ; Disease Progression ; Humans ; Multivariate Analysis ; Prevalence ; Quality of Life ; Recurrence* ; Risk Factors ; Survivors* ; Uterine Cervical Neoplasms*

OBJECTIVE: To determine the impact of time interval (TI) from radical hysterectomy with pelvic node dissection (RHND) to adjuvant therapy on oncological outcomes in cervical cancer. METHODS: The study included 110 stage IA2–IB1 cervical cancer patients who underwent RHND and adjuvant therapy. The patients were divided into 2 groups based on the cut-off points of TI of 4 and 6 weeks, respectively. The associations of TI and clinicopathologic factors with oncological outcomes were evaluated using Cox proportional-hazards regression. RESULTS: The median TI was 4.5 weeks. There were no statistical differences in 5-year recurrence-free survival (RFS) (89.2% vs. 81.0%, and 83.2% vs. 100.0%) or 5-year overall survival (OS) rates (90.9% vs. 97.2%, and 93.2% vs. 100.0%) between patients according to TI (≤4 vs. >4, and ≤6 vs. >6 weeks, respectively). Deep stromal invasion (p=0.037), and parametrial involvement (PI) (p=0.002) were identified as independent prognostic factors for RFS, together with the interaction between TI and squamous cell carcinoma histology (p<0.001). In patients with squamous cell carcinoma, a TI longer than 4 weeks was significantly associated with a worse RFS (hazard ratio [HR]=15.8; 95% confidence interval [CI]=1.4–173.9; p=0.024). Univariate analysis showed that only tumor size (p=0.023), and PI (p=0.003) were significantly associated with OS. CONCLUSION: Delay in administering adjuvant therapy more than 4 weeks after RHND in early stage squamous cell cervical cancer results in poorer RFS.
Carcinoma, Squamous Cell ; Chemoradiotherapy, Adjuvant ; Epithelial Cells ; Humans ; Hysterectomy* ; Prognosis ; Radiotherapy, Adjuvant ; Time Factors ; Uterine Cervical Neoplasms*