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Background <p>Adjuvant concurrent chemoradiotherapy following radical hysterectomy is the cornerstone of curative-intent treatment for early-stage cervical cancer. However, among people living with Human Immunodeficiency Virus (PLWHIV) and cervical cancer, the interplay of treatment toxicity, immunosuppression and systemic health barriers presents a compounded clinical challenge. Evidence on how HIV infection influences baseline clinical patterns and prognosis following standard multimodal therapy remains poorly characterized.</p> Methods <p>We conducted a descriptive retrospective cohort review of women with FIGO 2018 stage IA–IIA cervical cancer who had completed curative-intent trimodal therapy (adjuvant pelvic external-beam radiotherapy (45–50.4&#xa0;Gy), weekly cisplatin (40&#xa0;mg/m²), and brachytherapy following radical hysterectomy (type II/III) with pelvic lymphadenectomy) between 2014 and 2023, at a tertiary referral hospital in Kenya. The baseline clinicopathological characteristics, treatment-related toxicities, 3-year disease-free survival (DFS), and 5-year overall survival (OS) were described. Results were stratified by HIV status. Survival analysis was conducted using Kaplan-Meier estimates and log-rank tests.</p> Results <p>Over the 10-year study period, 275 patients with cervical cancer underwent radical hysterectomy with bilateral pelvic lymphadenectomy. Of 62 patients meeting criteria for adjuvant therapy (17 PLWHIV, 45 HIV-negative), 38 (61.3%) completed trimodal therapy. This corresponded to a completion rate of 76.5% (13/17) among PLWHIV versus 55.6% (25/45) among HIV-negative patients. Baseline clinicopathological profiles, including age, performance status, and histology (squamous cell carcinoma: 100% versus 88.0%) did not differ substantially between groups. Positive lymph nodes were the most common high-risk feature (53.8% versus 40.0%), and lymphovascular space invasion (LVSI) was the predominant intermediate-risk feature (69.2% versus 40.0%). Median time from surgery to adjuvant therapy initiation was 77.5 days (IQR 42–210). Lymphedema (21.1%) and bladder dysfunction (18.4%) were the frequently reported any-grade chronic toxicities. Myelosuppression occurred in 23.1% versus 4.0%. The 3-year DFS was 53.8% among PLWHIV and 77.6% among HIV-negative patients (log-rank <i>p</i> = 0.14); median OS was 14.5 months versus 21.1 months (log-rank <i>p</i> = 0.12). Five-year survival estimates were not attainable for PLWHIV due to early recurrence and mortality.</p> Conclusion <p>Despite comparable baseline characteristics, PLWHIV showed a nonsignificant trend toward greater treatment-related toxicity and reduced survival following trimodal therapy for early-stage cervical cancer. These findings underscore the importance of regional strengthening of HIV-oncology integrated services, and generating prospective research on optimum management strategies for this vulnerable cohort.</p>

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Characterizing trimodal therapy outcomes by HIV status in early-stage cervical cancer: a retrospective cohort study from a Kenyan tertiary centre

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  • 发表日期：

    2026年3月9日

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  • Gabriel Eliazaro Ouma,
  • Kimbley Asaso Omwodo,
  • Peter Itsura,
  • Philippe Amubuomombe Poli,
  • Kanguru Wahome,
  • Odhiambo Otieno,
  • Nasengo Chiriswa,
  • Green Harris Jose,
  • Adagi Awuor,
  • Barry Rosen,
  • Allan Covens,
  • Philip Tonui

摘要

Background

Adjuvant concurrent chemoradiotherapy following radical hysterectomy is the cornerstone of curative-intent treatment for early-stage cervical cancer. However, among people living with Human Immunodeficiency Virus (PLWHIV) and cervical cancer, the interplay of treatment toxicity, immunosuppression and systemic health barriers presents a compounded clinical challenge. Evidence on how HIV infection influences baseline clinical patterns and prognosis following standard multimodal therapy remains poorly characterized.

Methods

We conducted a descriptive retrospective cohort review of women with FIGO 2018 stage IA–IIA cervical cancer who had completed curative-intent trimodal therapy (adjuvant pelvic external-beam radiotherapy (45–50.4 Gy), weekly cisplatin (40 mg/m²), and brachytherapy following radical hysterectomy (type II/III) with pelvic lymphadenectomy) between 2014 and 2023, at a tertiary referral hospital in Kenya. The baseline clinicopathological characteristics, treatment-related toxicities, 3-year disease-free survival (DFS), and 5-year overall survival (OS) were described. Results were stratified by HIV status. Survival analysis was conducted using Kaplan-Meier estimates and log-rank tests.

Results

Over the 10-year study period, 275 patients with cervical cancer underwent radical hysterectomy with bilateral pelvic lymphadenectomy. Of 62 patients meeting criteria for adjuvant therapy (17 PLWHIV, 45 HIV-negative), 38 (61.3%) completed trimodal therapy. This corresponded to a completion rate of 76.5% (13/17) among PLWHIV versus 55.6% (25/45) among HIV-negative patients. Baseline clinicopathological profiles, including age, performance status, and histology (squamous cell carcinoma: 100% versus 88.0%) did not differ substantially between groups. Positive lymph nodes were the most common high-risk feature (53.8% versus 40.0%), and lymphovascular space invasion (LVSI) was the predominant intermediate-risk feature (69.2% versus 40.0%). Median time from surgery to adjuvant therapy initiation was 77.5 days (IQR 42–210). Lymphedema (21.1%) and bladder dysfunction (18.4%) were the frequently reported any-grade chronic toxicities. Myelosuppression occurred in 23.1% versus 4.0%. The 3-year DFS was 53.8% among PLWHIV and 77.6% among HIV-negative patients (log-rank p = 0.14); median OS was 14.5 months versus 21.1 months (log-rank p = 0.12). Five-year survival estimates were not attainable for PLWHIV due to early recurrence and mortality.

Conclusion

Despite comparable baseline characteristics, PLWHIV showed a nonsignificant trend toward greater treatment-related toxicity and reduced survival following trimodal therapy for early-stage cervical cancer. These findings underscore the importance of regional strengthening of HIV-oncology integrated services, and generating prospective research on optimum management strategies for this vulnerable cohort.