Factors Relating to Poor Survival Rates of Aged Cervical Cancer Patients: a Population-based Study with the Relative Survival Model in Osaka, Japan

Poor survival of older cervical cancer patients has been reported; however, related factors , such as theextent of disease and the competitive risk by aging have not been well evaluated. We applied the relative survivalmodel developed by Dickman et al to resolve this issue. Study subjects were cervical cancer patients retrievedfrom the Osaka Cancer Registry. They were limited to the 10,048 reported cases diagnosed from 1975 to 1999,based on the quality of data collection on vital status. Age at diagnosis was categorized into <30, 30-54, 55-64,and 65+ years. The impact of prognostic factors on 5-year survival was evaluated with the relative survivalmodel, incorporating patients’ expected survival in multivariate analysis. The age-specific relative excess risk(RER) of death was significantly higher for older groups as compared with women aged 30-54 years (RER, 1.58at 55-64 and 2.51 at 65+ years). The RER was decreased by 64.8% among the 55-64 year olds as an effect ofcancer stage at diagnosis, and by 43.4% among those 65 years old and over. After adding adjustment fortreatment modalities, the RER was no longer significantly higher among 55-64 year olds; however, it was stillhigher among 65 year olds and over. Advanced stage at diagnosis was the main determinant of poor survivalamong the aged cervical cancer patients, although other factors such as limitations on the combination of treatmentwere also suggested to have an influence in those aged 65 years and over.