The impact of chemotherapy on survival in patients aged ≥65 years with locoregionally cervical cancer who undergo radiotherapy: a Surveillance, Epidemiology, and End Results database analysis
Cervical cancer remains a global health challenge, particularly among patients aged ≥65 years, who often face poorer outcomes. This study aims to evaluate the clinical significance of chemotherapy in older patients (≥65 years) who undergo definitive radiotherapy for cervical cancer, using data from the Surveillance, Epidemiology, and End Results database. A retrospective cohort study was conducted using data from the Surveillance, Epidemiology, and End Results 18 Registries, focusing on patients with cervical cancer aged ≥65 years who were diagnosed between 2004 and 2017. Patients receiving surgery or those without radiotherapy were excluded. Propensity score matching was used to balance the baseline characteristics in patients treated with and those without chemotherapy. Overall survival and cancer-specific survival were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. A total of 2958 patients met the inclusion criteria, and 69.8% (n = 2067) received chemotherapy. Chemotherapy significantly improved 5- and 10-year overall survival rates (47.8% vs 26.9%, 28.5% vs 11.1%, respectively; HR 0.55, 95% CI 0.49 to 0.61, p < .0001) and cancer-specific survival rates (58.7% vs 43.8%, 48.3% vs 38.7%, HR 0.64, 95% CI 0.56 to 0.73). Multi-variate analysis identified chemotherapy, International Federation of Gynecology and Obstetrics stage, and histology as independent prognostic factors for both overall survival and cancer-specific survival. The impact of chemotherapy decreased slightly in more advanced stages, particularly stage IVA, but remained beneficial in earlier stages and among the oldest age groups (≥85 years). Chemotherapy significantly improves both overall survival and cancer-specific survival in patients aged ≥65 years with locoregionally advanced cervical cancer who undergo radiotherapy. These findings strongly support the inclusion of chemotherapy in treatment regimens for older patients, regardless of age, to optimize survival outcomes and ensure comprehensive care. Further research is essential to develop better strategies for managing advanced-stage diseases in older patients.
