Treatment-related Risk of Urologic Adverse Events in Cervical Cancer Survivors

To evaluate the risk of urologic adverse events (UAE), including ureteral complications and urinary fistula, in women treated for cervical cancer to inform clinical decision-making and improve survivorship quality of life.

Using the Merative MarketScan database (2011-2021), patients with cervical cancer were identified. Exclusions included <1 year pre-diagnosis enrollment, prior radiotherapy, pre-existing UAE, or multiple gynecologic cancers. Patients were categorized by treatment: surgery alone, surgery + chemotherapy, radiation ± other therapies, no/local treatment, and chemotherapy or radiation alone (surrogate for metastatic disease). Healthy age-matched controls were used. Multivariate Cox models and Kaplan-Meier analyses estimated UAE risk over time. UAEs were stratified as low-, intermediate and high-grade events.

Among 96,522 patients (68,990 cases and 27,532 controls), higher rates of all UAE were observed in cervical survivors than controls (23.2% vs 17.9%, P < .001). The highest risks of UAE were observed in patients with presumed non-metastatic disease who received radiation (low-grade UAE: HR 3.7, P < .001; intermediate-grade: HR 9.6, P < .001; high-grade UAE: HR 13.7, P < .001, ureteral: HR 23.5, P < .001, and fistula: HR 63.3, P < .001).

Cervical cancer treatment, particularly involving radiation, is associated with substantial risk high-grade UAE, ureteral and fistula complications. For young patients with localized and presumably curable disease, improved counseling, monitoring, and research to mitigate these highly morbid urologic complications is imminently warranted.