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To what extent do age, stage and treatment influence survival after invasive cervical cancer: a French population-based study

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Abstract

Purpose

In an attempt to understand why cervical cancer (CC) survival is decreasing with diagnosis period among older women in France, this study aimed to estimate the effects of main prognostic factors on net survival in CC according to age.

Methods

French cancer registries databases were used to retrospectively analyze women diagnosed with CC in 2011–2012. Net survival was estimated with the Pohar-Perme method and prognostic factors (socio-demographic, clinical variables, stage at diagnosis, therapeutic management) were analyzed with Lambert and Royston’s flexible parametric model.

Results

One thousand one hundred fifty three women with CC were identified. 30.4% were < 45, 41.4% 45–64, and 28.3% ≥ 65 years. Older women were diagnosed at a more advanced stage than younger women: 54.8% regional (FIGO IB2-IVA), 33.0% distant (IVB) in women ≥ 65 years vs 33.7% and 8.0%, respectively in women < 45 years. Half of women with regional stage of CC received recommended treatment; this rate decreased with increasing age (< 45: 66.1%, 45–64: 62.7%, ≥ 65: 29.2%). Older age was significantly associated with increased risk of death: hazard ratio 1.89 for age ≥ 65, as were regional stage (2.81), distant stage (15.99), and not receiving recommended treatment (2.26).

Conclusion

Older women with CC diagnosed at advanced stage who do not receive standard of care are at markedly increased risk of death. Special attention to the management of older women is warranted in France, not only to diagnose cancer at an earlier stage (via gynecological follow-up in these menopaused women who remain at risk of CC), but also to ensure they receive standard of care, taking into account their overall state of health.

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Data availability

The data can be made available upon reasonable request.

Abbreviations

ADC:

Adenocarcinoma

ASNS:

Age-standardized net survival

CC:

Cervical cancer

CCRB:

Concurrent chemoradiotherapy plus intracavitary brachytherapy

CI:

Confidence interval

EDI:

European Deprivation Index

FIGO:

International Federation of Obstetrics and Gynecology

HR:

Hazard ratio

IARC:

International Agency for Research on Cancer

INSEE:

Institut National de la Statistique et des Etudes Economiques

IQR:

Interquartile range

NS:

Net survival

Q:

Quintile

TNM:

Tumor Node Metastasis

SCC:

Squamous cell carcinoma

SEER :

Surveillance, Epidemiology, and End Results Program

WHO:

World health organization

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Acknowledgments

The authors thank all those who contributed to the inclusion of cancer patients in the registries, in particular pathologists, medical informatics staff in public and private healthcare institutions, medical staff of health insurance companies, chest physicians and oncologists, as well as medical practitioners. French cancer registries are supported by the Institut National du Cancer, Santé Publique France, Direction Générale de l'Offre de Soins, local institutions and League Against Cancer. The authors thank Fiona Ecarnot, PhD (EA3920, University of Franche-Comté, Besançon, France) for translation and editorial assistance. The authors also thank Morgane Mounier for her advice on the choice of statistical model.

Funding

This study was partly supported for data collection and analysis by a grant from the French National Cancer Institute (INCa), related to the DEPREV-2017 program. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Doubs Cancer Registry, Besançon University Hospital, Besançon, France

    Zoéwendtalé Cyrille Compaoré, Aurélie Gérazime & Anne-Sophie Woronoff

  2. Research Unit EA3181, Franche-Comté University, Besançon, France

    Zoéwendtalé Cyrille Compaoré, Aurélie Gérazime & Anne-Sophie Woronoff

  3. INSERM CIC 1431, Besançon University Hospital, Besançon, France

    Elisabeth Monnet

  4. Loire-Atlantique/Vendée Cancer Registry, SIRIC-ILIAD, Nantes, France

    Florence Molinié

  5. French Network of Cancer Registries (Francim), Toulouse, France

    Florence Molinié, Anne-Valérie Guizard, Patricia Delafosse, Tienhan Sandrine Dabakuyo-Yonli, Gaëlle Coureau, Karima Hammas, Sandrine Plouvier, Simona Bara, Gautier Défossez, Bénédicte Lapôtre-Ledoux, Laetitia Daubisse-Marliac, Tania d’Almeida, Brigitte Trétarre & Anne-Sophie Woronoff

  6. Calvados General Cancer Registry, Caen, France

    Anne-Valérie Guizard

  7. INSERM U1086 “Anticipe”, Centre François Baclesse, Caen, France

    Anne-Valérie Guizard & Guy Launoy

  8. Isère Cancer Registry, Grenoble, France

    Patricia Delafosse

  9. Côte d’Or Cancer Registry, Dijon, France

    Tienhan Sandrine Dabakuyo-Yonli

  10. Gironde General Cancer Registry, Bordeaux, France

    Gaëlle Coureau

  11. Haut-Rhin Cancer Registry, Mulhouse, France

    Karima Hammas

  12. Lille General Cancer Registry, Lille, France

    Sandrine Plouvier

  13. Manche Cancer Registry, Cherbourg-en-Cotentin, France

    Simona Bara

  14. Poitou-Charentes Cancer Registry, Poitiers, France

    Gautier Défossez

  15. Somme Cancer Registry, Amiens, France

    Bénédicte Lapôtre-Ledoux

  16. Tarn Cancer Registry, Albi, France

    Laetitia Daubisse-Marliac

  17. Haute-Vienne Cancer Registry, Limoges, France

    Tania d’Almeida

  18. Department of Medical Oncology, Besançon University Hospital, Besançon, France

    Laura Mansi

  19. Hérault Cancer Registry, Montpellier, France

    Brigitte Trétarre

Authors
  1. Zoéwendtalé Cyrille Compaoré
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  2. Elisabeth Monnet
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  3. Aurélie Gérazime
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  4. Florence Molinié
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  5. Anne-Valérie Guizard
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  6. Patricia Delafosse
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  7. Tienhan Sandrine Dabakuyo-Yonli
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  8. Gaëlle Coureau
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  9. Karima Hammas
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  10. Sandrine Plouvier
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  11. Simona Bara
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  12. Gautier Défossez
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  13. Bénédicte Lapôtre-Ledoux
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  15. Tania d’Almeida
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  19. Anne-Sophie Woronoff
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Contributions

Conceptualization: Anne-Sophie Woronoff, Elisabeth Monnet; Methodology: Anne-Sophie Woronoff, Zoéwendtalé Cyrille Compaoré, Elisabeth Monnet, Aurélie Gérazime; Data curation: Anne-Sophie Woronoff, Zoéwendtalé Cyrille Compaoré, Aurélie Gérazime; Formal analysis: Anne-Sophie Woronoff, Zoéwendtalé Cyrille Compaoré, Aurélie Gérazime; Investigation: Anne-Sophie Woronoff, Florence Molinié, Anne-Valérie Guizard, Patricia Delafosse Tienhan Sandrine Dabakuyo-Yonli, Brigitte Trétarre. Gaëlle Coureau, Karima Hamas, Sandrine Plouvier, Simona Bara, Gautier Défossez, Bénédicte Lapôtre-Ledoux, Laetitia Daubisse-Marliac, Tania d’Almeida; Project administration: Anne-Sophie Woronoff; Writing—original draft preparation: Zoéwendtalé Cyrille Compaoré, Anne-Sophie Woronoff; Writing—review and editing: Zoéwendtalé Cyrille Compaoré, Anne-Sophie Woronoff, Elisabeth Monnet, Aurélie Gérazime, Florence Molinié, Anne-Valérie Guizard, Patricia Delafosse Tienhan Sandrine Dabakuyo-Yonli, Guy Launoy, Laura Mansi, Brigitte Trétarre; Funding acquisition: Anne-Sophie Woronoff; Resources: Anne-Sophie Woronoff, Florence Molinié, Anne-Valérie Guizard, Patricia Delafosse Tienhan Sandrine Dabakuyo-Yonli, Brigitte Trétarre. Gaëlle Coureau, Karima Hamas, Sandrine Plouvier, Simona Bara, Gautier Défossez, Bénédicte Lapôtre-Ledoux, Laetitia Daubisse-Marliac, Tania d’Almeida; Supervision and validation: Anne-Sophie Woronoff, Elisabeth Monnet.

Corresponding author

Correspondence to Anne-Sophie Woronoff.

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Conflict of interest

The authors have no conflict of interest to declare.

Consent for publication

Not applicable. In accordance with French legislation governing medical research, no ethics committee approval was required for this registry-based study. The Registry has approval from the French national commission for data privacy for the ongoing collection of data.

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Appendices

Appendix 1: Morphology codes [12]

According to the IARC’s Cancer Incidence in five continents volume XI (CI5-XI), tumors were classified as:

  • Squamous cell carcinoma: [8050–8078], [8083–8084].

  • Adenocarcinoma: [8140–8141], [8190–8211], [8230–8231], [8260–8265], 8310, 8380, [8382–8384], [8440–8490], [8570–8574], 8576.

  • Other specified and unspecified: 8000, 8010, 8013, 8020, 8033, 8041, 8045, 8082, 8089, 8098, 8120, 8144, 8246, 8430, 8560, 8720, 8740.

Appendix 2: Condensed stage into 3 groups according to correspondence between TNM and FIGO [13]

Stage FIGO

T

N

M

Localized

   

Stage I

T1

N0

M0

Stage IA

T1a

N0

M0

Stage IA1

T1a1

N0

M0

Stage IA2

T1a2

N0

M0

Stage IB

T1b

N0

M0

Stage IB1

T1b1

N0

M0

Regional

   

Stage IB2

T1b2

N0

M0

Stage II

T2

N0

M0

Stage IIA

T2a

N0

M0

Stage IIA1

T2a1

N0

M0

Stage IIA2

T2a2

N0

M0

Stage IIB

T2b

N0

M0

Stage III

T3

N0

M0

Stage IIIA

T3a

N0

M0

Stage IIIB

T3b

Any N

M0

 

T1, T2, T3

N1

 

Stage IVA

T4

Any N

M0

Distant

   

Stage IVB

Any T

Any N

M1

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Compaoré, Z.C., Monnet, E., Gérazime, A. et al. To what extent do age, stage and treatment influence survival after invasive cervical cancer: a French population-based study. Cancer Causes Control 33, 403–415 (2022). https://doi.org/10.1007/s10552-021-01536-9

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  • DOI: https://doi.org/10.1007/s10552-021-01536-9

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