Management and Survival of Inpatients With Stage Iiib Cervical Cancer With Hydronephrosis Admitted at Kenyatta National Hospital, 2012-2017

Abstract

Introduction: In FIGO stage IIIB cervical cancer, the carcinoma involves the lower third of the vagina with extension to the pelvic wall and/or hydronephrosis or non-functioning kidney. Patients with hydronephrosis have worse morbidity compared to those with extension to pelvic wall only. Morbidity among patients with hydronephrosis include acute renal injury and ultimate poor survival. Outcomes for patients with FIGO stage IIIB cervical cancer has not been evaluated in Kenyatta National Hospital. This is particularly important, because majority of mortalities in cervical cancer patients is due to renal complications. Broad Objective: To evaluate the management and survival of inpatient FIGO stage IIIB cervical cancer patients with hydronephrosis admitted at KNH between 2012 and 2017 Methodology Study design: Retrospective descriptive cohort Study site and setting: Kenyatta National Hospital Study population: Cervical cancer patients with FIGO stage IIIB with hydronephrosis Sample size: 448 Data collection: Descriptive variables, variables on management of hydronephrosis, date and time of death were collected. Data was captured electronically into the REDcap software. Data analysis: Data with descriptive statistics were summarized. Age was presented as means (SD), while categorical data was presented in proportions. Survival was presented as median (IQR) and Kaplan Meier curves were used to determine 2- and 5-year survivals. Results: The overall mean (SD) age was 49.1(11.8) years. A total of 252 patients had their histology report in the file, out of these, 89% (224/448) were squamous cell carcinoma. The median (IQR) survival in months was 1.4 (0.4-5.4). Most patients (55%) had their cancer treatment written as radiotherapy given, without details on if concurrent chemotherapy was given, type of radiation, radiation dose or number of cycles. Most (75%) patients presented with bilateral hydronephrosis, over 80% had ungraded hydronephrosis, and over 60% had no decompression for their hydronephrosis. Patients who received decompression for hydronephrosis had better 2 and 5-year survival compared to those who did not, though by a few days, log rank test p= <0.001. Conclusion: Squamous cell carcinoma is the commonest histologic type in inpatient FIGO stage IIIB cervical cancer patients with hydronephrosis admitted and managed at KNH between 2012 and 2017. Radiotherapy treatment was not clearly indicated in most, had bilateral hydronephrosis and decompression was not offered for many patients. The overall median survival in months (IQR) was 1.4(0.4-5.4). Though patients who received decompression for hydronephrosis had better survival, this is only by a few days. Decompression of hydronephrosis should not delay definitive chemoradiation therapy.