title: Cervical cancer survival for patients referred to a tertiary care center in Kentucky.
abstract: OBJECTIVE
  To identify prognostic factors influencing cervical cancer survival for patients referred to a tertiary care center in Kentucky.
  
  
  METHODS
  A cohort study was performed to assess predictive survival factors of cervical cancer patients referred to the University of Kentucky from January 2001 to May 2010. Eligibility criteria included those at least 18 years-old, cervical cancer history, and no prior malignancy. Descriptive statistics were compiled and univariable and multivariable Cox proportional hazard analysis were performed.
  
  
  RESULTS
  381 patients met entry criteria. 95% were Caucasian (N=347) and 66% (N=243) lived in Appalachian Kentucky. The following covariates showed no evidence of a statistical association with survival: race, body mass index, residence, insurance status, months between last normal cervical cytology and diagnosis, histology, tumor grade, and location of primary radiation treatment. After controlling for identified significant variables, stage of disease was a significant predictor of overall survival, with estimated relative hazards comparing stages II, III, and IV to stage I of 3.09 (95% CI: 1.30, 7.33), 18.11 (95% CI: 7.44, 44.06), and 53.03(95% CI: 18.16, 154.87), respectively. The presence of more than two comorbid risk factors and unemployment was also correlated with overall survival [HR 4.25 (95% CI: 1.00, 18.13); HR 2.64 (95% CI 1.29, 5.42), respectively].
  
  
  CONCLUSIONS
  Residence and location of treatment center are not an important factor in cervical cancer survival when a tertiary cancer center can oversee and coordinate care; however, comorbid risk factors influence survival and further exploration of disease comorbidity related to cervical cancer survival is warranted.
authors.affiliation: Division of Gynecologic Oncology, The University of Kentucky College of Medicine and College of Public Health, Lexington, KY, USA. leighseamon@mac.com
authors.forename: Leigh G
authors.initials: LG
authors.lastname: Seamon
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Tarrant
authors.forename: Steve T
authors.initials: ST
authors.lastname: Fleming
authors.forename: Robin C
authors.initials: RC
authors.lastname: Vanderpool
authors.forename: Sarah
authors.initials: S
authors.lastname: Pachtman
authors.forename: Iwona
authors.initials: I
authors.lastname: Podzielinski
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Branscum
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Feddock
authors.forename: Marcus E
authors.initials: ME
authors.lastname: Randall
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Desimone
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D055815:Young Adult