Stage distribution and survival outcome in a real-world cervical cancer cohort from an urban-dominant population in Indonesia.

Abstract

219 Background: Cervical cancer is the second most common female malignancy in Indonesia and remains one of the leading causes of cancer morbidity and mortality in low- and middle-income countries. While urban areas are commonly associated with greater community awareness and access to healthcare than their rural counterparts, real-world data on stage distribution and survival outcome comparisons between these two areas are still limited. This study aimed to describe the clinicopathological distribution and short-term survival outcomes in a real-world cervical cancer cohort in one of the cancer referral centers in Indonesia. Methods: This retrospective observational study included cervical cancer patients treated at a high-volume oncology center in North Sumatra, Indonesia, between January and December 2024. Patient data, such as clinicopathologic characteristics and residential location, were collected from medical records. Survival outcomes were evaluated and compared using Kaplan-Meier estimation and the log-rank test. Results: This study included 162 patients with a median age of 53 years, ranging between 29 and 89 years. The majority of patients had squamous cell carcinoma (83.2%), an ECOG performance status of 0-1 (92.6%), and lived in urban settings (63.6%). The 116 patients with available staging data consisted of 63.8% who exhibited stage III disease and 20.7% with stage IV disease, indicating a significant prevalence of advanced-stage disease. Notably, stage IV patients were dominated by urban residents (62.5%). The percentage of distant metastasis (stage IVB) was comparable between urban and rural patients, at 10.7% and 10.1%, respectively. In terms of treatment completion, only 84% of the 100 patients intended to receive concurrent chemoradiation and brachytherapy completed their treatment. During a median follow-up period of 7.3 months (95% CI 6.4–8.3), 27 patients (16.7%) died and 19 (11.7%) showed disease progression. The one-year overall survival (OS) rate was 66.7% for stage IVA and 57% for stage IVB cervical cancer (log-rank p=0.017). Conclusions: Despite the predominance of urban residents within our real-world cohort, a large proportion of patients presented with late-stage disease. Our findings suggest persistent delays in diagnosis, even in settings where better healthcare accessibility is expected. Health system gaps surrounding public awareness, early detection, and timely diagnosis serve as targets for national health system reform, regardless of location.