Radical surgery for early cervical cancer in a resource limited setting: survival and challenges

Introduction: Cervical cancer is one of the most common cancers affecting women, with the highestincidence and mortality rates reported in East Africa. This study aimed to evaluate the outcomes of patientswith early-stage cervical cancer treated with radical surgery in Western Kenya.Methodology: This was a retrospective study of 131 consecutive patients with early cervical cancer (FIGOstage IA2 - IIA) treated over 5 years at Moi Teaching and Referral Hospital in Western Kenya. Nonparametricstatistics, the log-rank test and Cox regression were used to evaluate the effects of the covariatesanalysed on survival.Results: The mean age was 44.8 years, and the modal age group was 41-50 years (38.9%). HIVseroprevalence was 45.8%, while squamous cell carcinoma was the predominant histologic type seen in123 (93.9%) patients. The surgical margins were positive in 4 (3.1%) patients. Pelvic nodal metastases wereseen in 42 (35.9%) patients. The number of patients who required adjuvant chemo-radiation was 51 (38.9%),but only 16 (31.4%) received it. All-cause mortality was 18.3%, with a five-year overall survival of 67.7%.The factors associated with mortality were age (HR=2.28, p <0.001), HIV positivity (HR=3.51, p=0.009),tumour size (HR=1.3, p=0.047), and use of neoadjuvant chemotherapy (HR= 2.70, p 0.033).Conclusions: HIV seropositivity and age (per 10-year increase) are significant predictors of poor survival.The mechanism by which HIV negatively impacts survival requires further investigation.