Evaluation of survival and associated prognostic clinical-pathologic factors among women undergoing surgery for early-stage cervical cancer at Kamuzu Central Hospital in Lilongwe, Malawi
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Date
2021-12-16
Authors
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Kamuzu University of Health Sciences
Abstract
Study Type
The proposed study is a retrospective cohort study that seeks to evaluate the survival
and its associated prognostic factors among patients who underwent radical
hysterectomy and or pelvic lymphadenectomy at Kamuzu Central Hospital for Invasive
Cervical Cancer between January 2015 to December 2020.
The Problem:
Invasive cervical cancer is the 4th most common cancer among women worldwide.
Malawi has one of the highest burdens of cervical cancer globally with age standardized
incidence rate of 75.9 and mortality of 49.8 per 100,000 populations. It is the commonest
cancer among women in Malawi, with over 4,000 new cases and 2,900 deaths annually.
Early invasive disease is treated by radical hysterectomy with/or without pelvic
lymphadenectomy and/or chemoradiation. Malawi has a limited number of gynecologists
to competently perform the required surgery for early-stage Invasive Cervical Cancer in
two of its four tertiary hospitals, resulting in long waiting lists for surgery, to the detriment
of some women who progress to inoperable stages before their scheduled surgery.
Although Kamuzu Kamuzu central Hospital has been performing operations for treatment
of early invasive cervical cancer since 2015, the survival of those patients has not been
evaluated. Furthermore, whereas some studies have linked clinical and pathologic factors
including age, disease stage, neoadjuvant chemotherapy, tumor-positive surgical
margins to survival outcomes, there is limited data on the same in sub-Saharan Africa,
including Malawi. Thus, an evidence-informed selection of patients for surgery is urgently
needed to maximize benefits among women in need of surgery for Invasive cervical
cancer. This study will provide preliminary data to inform patient selection and counselling
for surgery for early-stage ICC. The study will also provide a foundation for further
research in this area.
Objectives
We aim to assess overall survival and determine its associated clinicopathological factors
among women who underwent radical hysterectomy +/- pelvic lymphadenectomy for
early-stage cervical cancer at Kamuzu Central Hospital in Lilongwe, Malawi. from January
2015 to December 2020.
Specifically, we shall determine overall and disease free survival as well as socialdemographic,
clinical and histopathological factors associated with survival.
Methodology
We shall review medical records and histopathology reports from the pathology lab
database. In addition to this, we plan to follow up patients using the contacts provided on
both health records and histopathology reports to determine their vital status and disease
status from health passport records, recorded during annual follow up visits. The data will
be collected using standardized Data Collection Form e and analyzed using Stata 15.0.
We will use Kaplan–Meier survival analyses to determine survival outcomes and Cox
proportional hazards regression to determine clinicopathologic factors associated with
survival outcome.
Expected findings
The expected findings include the five-year overall survival, disease free survival
expressed as a percentage of total number operated, and social, clinical and
histopathological factors that are associated with the survival.
Dissemination
The findings of this study shall be shared with the Department of Obstetrics and
Gynecology at Kamuzu Central Hospital, Malawi Ministry of Health and Population,
through the Department of Reproductive Health and COMREC. Further to this, we intend
to present our findings at the Association of Obstetrics and Gynecologist of Malawi Annual
Scientific Conference, KUHeS Research Dissemination Conference and other
international conferences targeting Obstetricians and Gynaecologists. We further intend
to submit the manuscript of this study for publication to both local and international
journals
Description
Keywords
Cervical cancer surgery