Cervical Cancer : Women Aged 35 and Younger Compared to Women Aged 36 and Older

<p> <strong> Purpose </strong></p><p> Age has been evaluated as a prognostic factor in cervical cancer in both hospital- and population-based studies. Results regarding the relation of age and cervical cancer prognosis are conflicting. This study pursued a contemporary assessment of the association of extreme young age at the time of a cervical cancer diagnosis on survival. <h3> Methods </h3></p><p> Institutional review board approval was obtained, and retrospective data collection at 2 academic institutions was performed. Inclusion criteria involved women &le;35 years diagnosed with cervical cancer between 1990 and 2012. Data included demographic and prognostic information pertinent to survival and progression. Characteristics of very young (&le;25 years) and young (&gt;25&ndash;35 years) women were compared. Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards modeling were used to assess the association of age, tumor histology, grade, stage, and parametrial involvement with progression-free survival (PFS) and overall survival (OS). <h3> Findings </h3></p><p> Incident cases (n = 126) of cervical cancer in patients &le;35 years of age were identified of which complete clinical information was available for 114 women. Fifteen percent (17 of 114) were &le;25 years, with the remaining 85% (97 of 114) being 26 to 35 years of age. Race, smoking status, and marital status were comparable between the 2 groups. Squamous histology dominated overall (77 of 114; 68%) with adenocarcinoma contributing ~25% (30 of 114; 26%) of cases. The majority (96 of 114, 84%) had either stage 1A (31 of 114, 27%) or 1B (65 of 114, 57%) disease. A log-rank test revealed no evidence to infer a difference in either PFS or OS among the age groups ( <em> P </em> = 0.511 and <em> P </em> = 0.340). In a univariate analysis, grade and stage significantly affected OS ( <em> P </em> &lt; 0.0001, <em> P </em> = 0.045), and stage significantly affected PFS ( <em> P </em> &lt; 0.0001). In multivariate modeling, presence of parametrial involvement and histologic cancer type significantly affected both PFS ( <em> P </em> = 0.002, <em> P </em> = 0.001) and OS ( <em> P </em> = 0.001, <em> P </em> = 0.001). <h3> Implications </h3></p><p> Tumor histology, parametrial involvement, and stage continue to be strong prognosticators for PFS and OS. Progression and survival outcomes are age independent in women with cervical cancer &le;35 years of age. Further study of a larger young cohort may potentially yield different outcomes.</p>