Abstract

Cervical cancer is a common gynecological malignancy, particularly in developing countries, where it coexists with renal impairment in over one-third of patients. This disease typically presents acutely and progresses rapidly. Consequently, kidney replacement therapy, including hemodialysis (HD), is commonly required. To assess survival rates and associated factors, this retrospective cohort study analyzed the medical records of 252 cervical cancer patients who began HD across a three-month follow-up period. Kaplan–Meier analysis indicated a median short-term survival duration of 71.5 days (range: 7–90), with 1-, 2-, and 3-month survival rates of 56%, 51%, and 49%, respectively. Multivariate Cox regression identified post-HD systolic blood pressure <110 mmHg (hazard ratio [HR] 3.354; 95% confidence interval [CI]: 2.346–4.795; p-value <0.001) and interdialytic weight gain ≥5% (HR 1.685; 95% CI: 1.125–2.521; p-value <0.011) as significant predictors of decreased survival. Other variables, including age, urea, albumin, vascular access, baseline creatinine, and cancer stage, were not significantly associated with short-term survival. These findings underscore the critical role of salt and fluid management, adherence to dietary and dialysis regimens, and close monitoring of weight in improving outcomes. Interventions targeting modifiable factors may improve the survival of cervical cancer patients who require HD. Such approaches, therefore, warrant further investigation.

References

1. Wu J, Jin Q, Zhang Y, et al. Global burden of cervical cancer: Current estimates, temporal trend and future projections based on the GLOBOCAN 2022. J Natl Cancer Cent. 2025; 11 (20): 322-329. DOI: 10.1016/j.jncc.2024.11.006.

2. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia Tahun 2021. Jakarta: Kementerian Kesehatan Republik Indonesia; 2022.

3. World Health Organization. Cervical cancer. Geneva: World Health Organization; 2025.

4. Hull R, Mbele M, Makhafola T, et al. Cervical cancer in low and middle-income countries (Review). Oncol Lett. 2020; 20 (3): 2058–2074. DOI: 10.3892/ol.2020.11754.

5. Kementrian Kesehatan Republik Indonesia. Pedoman Nasional Pelayanan Kedokteran Tata Laksana Kanker Serviks. Jakarta: Kementrian Kesehatan Republik Indonesia; 2019.

6. Yang Y-R, Chen S-J, Yen P-Y, et al. Hydronephrosis in patients with cervical cancer is an indicator of poor outcome: A nationwide population-based retrospective cohort study. Med. 2021; 100 (6): e24182. DOI: 10.1097/MD.0000000000024182

7. Damian FB, de Almeida FK, Fernandes FS et al. Impact of hydronephrosis and kidney function on survival in newly diagnosed advanced cervical cancer. Gynecol Oncol Rep. 2022; 39: 100934. DOI: 10.1016/j.gore.2022.100934.

8. Małyszko J, Kozlowski L, Kozłowska K, et al. Cancer and the kidney: Dangereoux liasons or price paid for the progress in medicine? Oncotarget. 2017; 8: 66601–66619. DOI: 10.18632/oncotarget.18094.

9. Wong G, Hayward JS, McArthur E, et al. Patterns and predictors of screening for breast and cervical cancer in women with CKD. Clin J Am Soc Nephrol. 2017; 12 (1): 95–104. DOI: 10.2215/CJN.05990616.

10. Zhang C-L, Xie D-Q, Ao L-N, et al. A comparative analysis of high-flux and low-flux dialysis in cervical cancer patients with obstructive renal failure showing no significantly improved renal function after catheterisation. Pak J Med Sci Q. 2021; 37 (4): 1014–1019. DOI: 10.12669/pjms.37.4.3515.

11. Reis D, Rocha E, Ishida TC. Clinical outcome and characteristics of patients with cervical cancer submitted to renal replacement therapy. J Clin Oncol. 2017; 35 (15_suppl): e21627–e21627. DOI: 10.1200/JCO.2017.35.15_suppl.e21627.

12. Daniels J, Asante K, Tackie JNO, et al. Survival rate of cervical cancer: A five year review at a Major Teaching Hospital in Ghana, West Africa. Ecancermedicalscience. 2024; 18: 1663. DOI: 10.3332/ecancer.2024.1663.

13. Madli F, Leong E, Ong SK, et al. Predictive factors associated with survival rate of cervical cancer patients in Brunei Darussalam. 2021; arXiv Preprint; arXiv: 2110.12057. DOI: 10.48550/arXiv.2110.12057

14. Teshome R, Yang I, Woldetsadik E, et al. Survival status and predictors among women with advanced stage of cervical cancer. Int J Women Health. 2024; 16: 605–617. DOI: 10.2147/IJWH.S455235.

15. Tesfaw A, Addissie A, Kantelhardt EJ, et al. Survival status and predictors of mortality among patients with cervical cancer in two oncology units in Northwest Ethiopia: A retrospective follow-up study. BMC Cancer. 2025; 26: 108. DOI: 10.1186/s12885-025-15444-7.

16. Muneeha S, Chaudhary RK, Shetty VV. et al. Exploring and detecting predictors associated with survival and mortality of cervical cancer patients: A 10-year retrospective study. Beni-Suef Univ J Basic Appl Sci. 2025; 14 (1): 13. DOI: 10.1186/s43088-025-00602-4.

17. Ola IO, Okunowo AA, Habeebu MY. Mortality risk stratification based on comorbidity status among cervical cancer patients in Lagos, Nigeria. Int Health. 2025; 17 (5): 669–677. DOI: 10.1093/inthealth/ihaf008.

18. Toriu N, Yamamoto S, Matsubara T, et al. Cancer diagnosis and prognosis after initiation of hemodialysis: Multicenter Japan CANcer and DialYsis (J-CANDY) study. Clin Kidney J. 2025; 18 (2): sfae430. DOI: 10.1093/ckj/sfae430.

19. Gadalean F, Ciorcan M, Apostol A, et al. Cancer before and after the start of hemodialysis and association with mortality - an Eastern-European multicenter study. Renal Failure. 2023; 45 (1): 2232046. DOI: 10.1080/0886022X.2023.2232046.

20. Kaliszewski K, Diakowska D, Nowak Ł, et al. The age threshold of the 8th edition AJCC classification is useful for indicating patients with aggressive papillary thyroid cancer in clinical practice. BMC Cancer. 2020; 20: 1166. DOI: 10.1186/s12885-020-07636-0.

21. Nixon IJ, Wang LY, Migliacci JC, et al. An international multi-institutional validation of age 55 years as a cutoff for risk stratification in the AJCC/UICC staging system for well-differentiated thyroid cancer. Thyroid. 2016; 26 (3): 373–380. DOI: 10.1089/thy.2015.0315.

22. Dekker M, Konings C, Canaud B, et al. Pre-dialysis fluid status, pre-dialysis systolic blood pressure and outcome in prevalent haemodialysis patients: Results of an international cohort study on behalf of the MONDO initiative. Nephrol Dial Transplant. 2018; 33 (11): 2027–2043. DOI: 10.1093/ndt/gfy095.

23. Huang X, Liu J, Zhang L, et al. Systolic blood pressure and 1-year clinical outcomes in patients hospitalized for heart failure. Front Cardiovasc Med. 2022; 9: 877293. DOI: 10.3389/fcvm.2022.877293.

24. Zemaitis MR, Foris LA, Katta S, et al. Uremia. 2024 March 29. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

25. Yoshikawa N, Yoshihara M, Tamauchi S, et al. Hypoalbuminemia for the prediction of survival in patients with organ metastatic cervical cancer. Res Square. 2021; 17 (9): e0273876. DOI: 10.21203/rs.3.rs-1048515/v1.

26. Wachterman MW, O’Hare AM, Rahman O, et al. One-year mortality after dialysis initiation among older adults. JAMA Intern Med. 2019; 179 (7): 987–990. DOI: 10.1001/jamainternmed.2019.0125.

27. Tabatabaei F-S, Saeedian A, Azimi A, et al. Evaluation of survival rate and associated factors in patients with cervical cancer: A retrospective cohort study. J Res Health Sci. 2022; 22 (2): e00552. DOI: 10.34172/jrhs.2022.87.

28. Wang W, Liu X, Meng Q, et al. Nomograms predicting survival and patterns of failure in patients with cervical cancer treated with concurrent chemoradiotherapy: A special focus on lymph nodes metastases. PLoS One. 2019; 14 (4): e0214498. DOI: 10.1371/journal.pone.0214498.

29. Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021; 155 Suppl 1 (S1): 28–44. DOI: 10.1002/ijgo.13865.

30. Miyasato Y, Hanna RM, Miyagi T, et al. Associations of interdialytic weight gain in the long intervals with mortality and residual kidney function decline. Hemodial Int. 2023; 27 (3): 326–338. DOI: 10.1111/hdi.13094.

31. Jalalzadeh M, Mousavinasab S, Villavicencio C, et al. Consequences of interdialytic weight gain among hemodialysis patients. Cureus. 2021; 13 (5): e15013. DOI: 10.7759/cureus.15013.

32. Kurita N, Hayashino Y, Yamazaki S, et al. Revisiting interdialytic weight gain and mortality association with serum albumin interactions: The Japanese dialysis outcomes and practice pattern study. J Ren Nutr. 2017; 27 (6): 421–419. DOI: 10.1053/j.jrn.2017.05.003.

33. Chun KH, Kang SM. Blood pressure and heart failure: Focused on treatment. Clin Hypertens. 2024; 30 (1): 15. DOI: 10.1186/s40885-024-00271-y.

34. Wang M, Zuo L. Early mortality risk in incident Chinese hemodialysis patients: A retrospective cohort study. Ren Fail. 2017; 39 (1): 5526–5532. DOI: 10.1080/0886022X.2017.1337583.

35. Heaf J, Heiro M, Petersons A, et al. First-year mortality in incident dialysis patients: Results of the Peridialysis study. BMC Nephrol. 2022; 23: 229. DOI: 10.1186/s12882-022-02852-1.

36. Arakawa H, Abe M, Sato Y, et al. Early mortality after the initiation of hemodialysis in elderly patients. Dokkyo Med J. 2024; 3 (1): 42–50. DOI: 10.51040/dkmj.2023-037.

37. Noh J, Park SY, Bae W, et al. Predicting early mortality in hemodialysis patients: A deep learning approach using a nationwide prospective cohort in South Korea. Sci Rep. 2024; 14: 29658. DOI: 10.1038/s41598-024-80900-6.

Download

Share

COinS