Five-year survival and prognostic factors of cervical cancer (stages I-IV) in Rwanda: a population-based analysis, 2017–2021

Abstract

Cervical cancer remains a leading cause of cancer-related mortality among women in low- and middle-income countries. This study assessed five-year survival and prognostic factors among patients diagnosed with cervical cancer in Rwanda. We conducted a population-based retrospective cohort study using data from the Rwanda National Cancer Registry, including patients diagnosed with cervical cancer (Stages I–IV) between 2017 and 2021. Survival probabilities were estimated using the Kaplan–Meier method, and prognostic factors were identified using Cox proportional hazards models. A total of 1,075 patients were included. The mean age at diagnosis was 54.1 years (SD 12.7). FIGO stage distribution at diagnosis was as follows: Stage I (9.0%), Stage II (18.7%), Stage III (32.0%), Stage IV (10.5%), and unknown stage (29.8%). During follow-up, 20.0% of patients died, while 77.7% were censored. An advanced stage at diagnosis was significantly associated with increased mortality (Stage IV vs. Stage I: aHR = 3.84, 95% CI: 1.98–7.45; p < 0.001). In sensitivity analyses, including a worst-case scenario in which the missing stage was classified as Stage IV, the association between advanced stage and mortality remained robust (Stage IV vs. Stage I: aHR = 2.43, 95% CI: 1.26–4.70; p = 0.008). Survival among cervical cancer patients in Rwanda remains strongly associated with stage at diagnosis. The high proportion of advanced-stage disease and missing stage data underscores the need for improved early detection, data completeness, and follow-up systems.