title: Cervical Cancer in Women Aged 35 Years and Younger.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Institutional review board approval was obtained, and retrospective data collection at 2 academic institutions was performed. Inclusion criteria involved women ≤ 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 (≤ 25 years) and young (>25-35 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).
  
  
  RESULTS
  Incident cases (n = 126) of cervical cancer in patients ≤ 35 years of age were identified of which complete clinical information was available for 114 women. Fifteen percent (17 of 114) were ≤ 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 (P = 0.511 and P = 0.340). In a univariate analysis, grade and stage significantly affected OS (P < 0.0001, P = 0.045), and stage significantly affected PFS (P < 0.0001). In multivariate modeling, presence of parametrial involvement and histologic cancer type significantly affected both PFS (P = 0.002, P = 0.001) and OS (P = 0.001, P = 0.001).
  
  
  CONCLUSIONS
  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 ≤ 35 years of age. Further study of a larger young cohort may potentially yield different outcomes.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia. Electronic address: elizabeth.pelkofski@bhsi.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pelkofski
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jessica
authors.initials: J
authors.lastname: Stine
authors.affiliation: Division of Translational Research and Applied Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
authors.forename: Nolan A
authors.initials: NA
authors.lastname: Wages
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.affiliation: Division of Gynecology Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Cantrell
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology*; D000328:Adult; D000367:Age Factors; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology*; D055815:Young Adult
keywords: age; cervical cancer; progression; survival; young women