Risk of Pelvic Insufficiency Fractures in Cervical Cancer Survivors: Using the National Claim Database

Abstract

Background: Cervical cancer, one of the most prevalent cancers among women worldwidely, has seen improved survival rates due to advancements in pelvic radiation therapy (RT). Several risk factors for pelvic insufficiency fracture (PIF) have been reported in patients with cervical cancer. This study aimed to estimate the incidence of PIFs in patients with cervical cancer and assess the potential risk factors for PIF using a national claim database. Methods: A total of 13,480 cervical cancer patients were identified during 2007 to 2016 from linkage between the Korea National Health Insurance Service and Korea Central Cancer Registry. Patients were identified and divided into PIF and non-PIF groups. The incidence of PIFs was estimated and risk factors for PIFs, including age, type of medical institution, residential area, insurance type, Surveillance, Epidemiology, and End Results summarized stage, RT and comorbidities, were assessed using multivariate Cox proportional hazards regression analysis. Results: In a cohort of 13,480 patients diagnosed with cervical cancer, PIF occurred in 134 (1.0%). Among the variables, older age (adjusted hazard ratio [aHR], 1.063; 95% confidence interval [CI], 1.047-1.079; P < 0.001) and RT (aHR, 1.829; 95% CI, 1.235-2.710; P = 0.003) were significantly associated with occurrence of PIF. Conclusion: The incidence of PIFs in cervical cancer survivors was 1.0% in this national claim database study and it demonstrated that RT and older age were significantly associated with an increased risk of PIF. Our findings suggest that clinicians should be aware of the risk of PIF, especially in older patients who underwent RT.