Determinants of Time to First Recurrence of Women with Cervical Cancer Using Fine and Gray Model: A Case Study at Jimma University Medical Center

Abstract

Background: Cervical Cancer is a cancer arising from the cervix. The cancer recurrence is when cancer cells are detected following the initial treatment. When there are competing risks, techniques like traditional survival analysis that censor the competing event produce overestimate of the risks. The Fine-Gray model is favored in this case over other methods of survival analysis. Objective: The aim of the study was to investigate the determinants of time to first recur- rence of woman with cervical cancer. Methods: A retrospective study was used to obtain data on women with cervical cancer that recorded in oncology department of Jimma Univeristy Medical Center. To reach the pro- posed objective, 280 women with cervical cancer were included in the study based on data taken from medical record card of patients enrolled starting from 1 st January 2017 to 31 st December 2021. Fine-Gray model were used to identifies which factor significantly affect time to first recurrence of cervical cancer by taking into account the occurrence of death as competing events. Results: Of280cervicalcancerpatients, 60(21.4%)experiencedfirstrecurrence, 64(22.9%) died without recurrence, and 156 (55.7%) experienced censored. The International Fed- eration of Gynecology and Obstetrics stage IV(SHR=3.71, 95%CI: 1.02-13.47, P=.046), smoker(SHR=3.34, 95%CI:1.43-7.81, P=.0053), HIVpositive(SHR=2.08, 95%CI:1.09-3.94, P=.0058), age at diagnosis ≥ 50 years (SHR=0.29, 95%CI:0.09- 0.9) and oral contraceptives users(SHR=2.2, 95%CI:1.09- 4.47, P=.029) were independently associated with recurrence of cervical cancer. Conclusion and recommendation: The International Federation of Gynecology and Ob- stetrics stage(IV), parity(Multipara and Grand multipara), HIV positive, smoker and oral contraceptive users increased the risk of recurrence. Age at diagnosis of ≥ 50 years and used chemo for two cycles, and three and more than three cycles decreases the risk of recurrence. To decrease the recurrence of cervical cancer, it is advised that policymakers, the ministry of health, and Jimma University Medical Center pay attention to individuals who are at a more advanced stage, smokers, HIV positive, and women who have several children