Department of Obstetrics and Gynaecology, Faculty of Medicine.
Department of Environmental Science, Faculty of Science, University of Botswana.
Int J Gynecol Cancer. 2018 Jul;28(6):1218-1225. doi: 10.1097/IGC.0000000000001284.
The aim of this study was to determine predictors of locally advanced disease at presentation and clinical outcomes among cervical cancer patients in Botswana to inform interventional strategies.
Retrospective review of 149 medical records of new cervical cancer patients was conducted between August 2016 and February 2017 at the Princess Marina Hospital. Data collected included sociodemographics, presenting symptoms, stage of disease, comorbidities, interventions, and clinical outcomes. STATA 12 was used for data analysis. Frequencies were used to describe patient demographics and clinical variables. Bivariate and multivariate binary logistic regression analyses were used to determine association between stage of disease at presentation and patient characteristics. P ≤ 0.05 was considered significant.
Mean age was 49.5 years. Nine (89.2%) in 10 patients had locally advanced cervical cancer (stage IB1-IVB). Two thirds (65.1%) were human immunodeficiency virus positive. Previous cervical cancer screening was low at 38.3%. Common symptoms were abnormal vaginal bleeding, low abdominal pain, and malodorous vaginal discharge reported among 75.8%, 66.4%, and 39.6% of cases, respectively. Overall, 32 (21.5%) were declared cured, 52 (34.9%) improved, and 11 (7.4%) opted for home-based care. Hospital deaths were 41 (27.5%). Major causes of death were renal failure (48.7%) and severe anemia (39%). Thirteen (8.7%) were lost to follow-up. Being unmarried (odds ratio [OR], 3.9), lack of cervical cancer screening (OR, 6.68), presentation with vaginal bleeding (OR, 7.69), and low abdominal pain (OR, 4.69) were associated with advanced disease at presentation.
Lack of cervical cancer screening, vaginal bleeding, low abdominal pain, and unmarried status were associated with advanced disease at presentation. We recommend scale-up of cervical cancer screening and its integration into routine human immunodeficiency virus care. Capacity building in gynecologic oncology and palliative care services is currently critical.
本研究旨在确定博茨瓦纳宫颈癌患者就诊时局部晚期疾病的预测因素和临床结局，为干预策略提供信息。
对 2016 年 8 月至 2017 年 2 月在 Princess Marina 医院就诊的 149 例新宫颈癌患者的病历进行回顾性分析。收集的数据包括社会人口统计学、临床表现、疾病分期、合并症、干预措施和临床结局。使用 STATA 12 进行数据分析。采用频率描述患者的人口统计学和临床特征。采用二变量和多变量二元逻辑回归分析来确定就诊时疾病分期与患者特征之间的关系。P≤0.05 被认为具有统计学意义。
平均年龄为 49.5 岁。10 例患者中有 9 例（89.2%）为局部晚期宫颈癌（IB1-IVB 期）。三分之二（65.1%）患者 HIV 阳性。以前的宫颈癌筛查率很低，为 38.3%。常见症状分别为异常阴道出血、下腹疼痛和恶臭阴道分泌物，分别占 75.8%、66.4%和 39.6%。总体而言，32 例（21.5%）患者被宣布治愈，52 例（34.9%）患者病情改善，11 例（7.4%）患者选择家庭护理。住院死亡 41 例（27.5%）。主要死亡原因是肾衰竭（48.7%）和严重贫血（39%）。13 例（8.7%）患者失访。未婚（比值比[OR]，3.9）、未行宫颈癌筛查（OR，6.68）、阴道出血（OR，7.69）和下腹疼痛（OR，4.69）与就诊时疾病进展相关。
宫颈癌筛查不足、阴道出血、下腹疼痛和未婚状态与就诊时疾病进展相关。我们建议扩大宫颈癌筛查范围，并将其纳入常规 HIV 护理。妇科肿瘤学和姑息治疗服务能力建设目前至关重要。
