Laila Nuranna1, Puja Agung Antonius1, Alfu Nikmatul Laily2, Fitriyadi Kusuma1, Kartiwa Hadi Nuryanto1
1Department of Obstetrics and Gynecology, Division of Gynecology Oncology, Faculty of Medicine, Dr. Cipto Mangunkusumo Central Hospital, Universitas Indonesia, Jakarta, Indonesia
2Female Cancer Programme, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Objective: This study was designed to define the differences between Stage IIIB cervical cancer patients with and without renal impairment (RI), particularly with regard to the pathology results, laboratory values, therapies, and prognoses, in order to justify the need for separate classifications for these two different patient types. Materials and Methods: A retrospective cohort technique was used to evaluate consecutive Stage IIIB cervical cancer patients from July 2010 to July 2015. The data collected included the age, parity, cancer cell type, pelvic wall involvement, hydronephrosis degree and bilateral involvement, laboratory values (urea, potassium, and creatinine), treatment modalities, 3-month postradiation treatment response, hospital stay duration, and 1-year survival rate. Results: The study patients included 102 Stage IIIB cervical cancer patients with RI and 204 individuals without RI. The results showed significant differences between individuals with and without bilateral pelvic wall involvement (100% vs. 68.1%, respectively), hydronephrosis degree (severe hydronephrosis incidences: 69% vs. 3.9%, respectively), bilateral hydronephrosis (96.5% vs. 6.9%, respectively), median urea level (148 vs. 22 mg/dl, respectively), median creatinine level (8.0 vs. 0.8 mg/dl, respectively), and median potassium level (5.8 vs. 3.9 mEq/L, respectively). The hazard ratio was 3.07 for the survival analysis. Conclusion: Cervical cancer patients with RI are faced with worst prognosis, and their treatment modalities are limited due to their renal comorbidities, resulting in lesser type of therapy modalities (such as chemotherapy procedure prohibition), longer hospital stays, and a lower survival rate. Therefore, a new classification for cervical cancer patients with kidney impairment, named Stage IIIB-plus, should be considered.
Keywords: Cervical cancer, IIIB, laboratory, pathology, renal impairment, therapy