Background In recent years, the incidence of cervical cancer is increasing, and the age of onset is younger. However, there are few studies on the influence factors of delayed diagnosis and treatment, as well as the impact of time of delay on prognostic of cervical cancer.
Objective To analyze the association between the delay in diagnosis and treatment of cervical cancer patients and their prognosis, as well as the factors contributing to the delay, providing guidance and assistance to patients seeking medical care in future.
Methods A retrospective analysis of clinical data about 457 patients aged from 26 to 84 years old with cervical cancer who were treated in Chinese PLA General Hospital from January 2011 to December 2015 was conducted. The time interval from the onset of symptoms to diagnosis (T1) was divided into two groups according to the median, and diagnostic delay was defined as the time interval of 107 days and more. Treatment delay was defined as the time interval (T2) of 28 days and more from diagnosis to primary treatment, referring to previous studies. The follow-up ended on May 31, 2022, and the end point was event-free survival (EFS). Multivariate binary logistic regression was used to determine the factors associated with diagnostic delay or treatment delay. Multivariate COX regression was used to analyze the relationship between delayed diagnosis and treatment and prognosis.
Results (1) Diagnostic delay: Cervical cancer patients living in small urban cities or rural area with a permanent population of less than 500,000 had greater risk of delay in diagnosis (OR=2.111, 95%CI: 1.080-4.125, P=0.029). Compared with asymptomatic patients, the patients with first symptoms of contact bleeding (OR=9.686, 95%CI: 4.683-20.033, P＜0.001), irregular vaginal bleeding (OR=3.193, 95%CI: 1.546-6.594, P=0.002) or vaginal drainage (OR=8.228, 95%CI: 3.004-22.534, P＜0.001) had a higher risk of delayed diagnosis. (2) Treatment dalay: The patients with first symptoms of contact bleeding (OR=0.117, 95%CI: 0.048-0.285, P＜0.001), irregular vaginal bleeding (OR=0.153, 95%CI: 0.061-0.380, P＜0.001) or vaginal drainage (OR=0.184, 95%CI: 0.038-0.883, P=0.034) were treated more promptly. (3) Prognosis: Progression and recurrence were observed in 41 patients, and 21 patients died during the follow-up. The 5-year EFS rate was 87.5%. Patients with delayed diagnosis (HR=1.805, 95%CI: 1.068-3.051, P=0.027) had adverse effects on the prognosis of patients. Compared with stage ⅠA1-ⅡA2 patients, stage ⅡB-ⅢA patients (HR=2.145, 95%CI: 1.047-4.394, P=0.037) and stage ⅢB-Ⅳ patients (HR=2.549, 95%CI: 1.366-4.755, P=0.003) had a worse prognosis.
Conclusion The delay in diagnosis of cervical cancer is related to first symptoms and residency. Treatment delay is associated to the first symptoms. Diagnostic delay may be associated with a poor prognosis. The health education about the cervical cancer prevention and control for small cities and rural areas should be carried out to improve the awareness of women's own health care.
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