Prognostic Factors for Cervical Cancer in FIGO-Stages IA-IIB in a 10-Year Period in the Region of Uppsala, Sweden: Population Cohort Study

Background: The incidence of cervical cancer in Sweden decreased to 8/100,000 in the year 2011 but has from 2014 increased to 11/100,000. The noted increase was, mainly observed in FIGO-stages IA-IB, where patients usually are asymptomatic and detected in screening. Materials and Methods: The study population consisted of 253 patients with cervical carcinoma in FIGO-stages IA-IIB. The patients were referred to the Department of Gynecology at the Akademiska University Hospital in Uppsala for decision of treatment from 2008 to 2017. Results: Clinical and pathological features of cervical carcinoma were compared according to the subtypes: squamous cell carcinoma (n=150), adenocarcinoma (n=74) and adeno-squamous cancer (n=29). Other rare histological types (n = 6) were excluded. Finally, 207 (82%) out of the 253 referred patients, had primary surgical treatment and 29 (14%) patients had additional oncological treatment. The remaining 46 patients (18%) received primary oncological treatment. In the present study 45 (17.8%) developed recurrent disease. Prognostic factors for disease-free survival in Cox-regression analysis were stage (IA versus IIB) (p = 0.000) and histopathologic subtype (p = 0.009). In a survival analysis the disease-free survival differed between the histological subtypes; 62 % for squamous cell cancer in cervix, 48 % for adenocarcinoma, and 32 % for adeno-squamous cancer (Chi-square = 6,221; p = 0,045)). Logistic regression analysis including treatment details, showed no other predictive factors for recurrent disease. Conclusion: The results from this study suggest that prognostic factors for disease-free survival are FIGO-stage (IA –IIB) and histopathology, but not tumor grade, age or choice of treatment.