Cervical Cancer Survival in Mali: A 21-Year Retrospective Cohort Study of Trends, Determinants, and Outcomes at Gabriel Touré Teaching Hospital (2003-2024).

Background and Aims: Cervical cancer (CC) remains a leading cause of cancer-related mortality among women in sub-Saharan Africa (SSA), particularly in Mali, where it is the most frequently diagnosed cancer and the leading cause of cancer-related death among women. Despite recent efforts, including expanded screening initiatives and the introduction of radiotherapy, most women continue to be diagnosed at advanced stages. This study aimed to assess long-term survival among women diagnosed with invasive CC at Gabriel Touré Teaching Hospital between 2003 and 2024 and to identify sociodemographic and clinical determinants of mortality. Methods: We conducted a retrospective cohort study including 3112 women with histologically confirmed invasive CC diagnosed between January 2003 and December 2024. Following data validation, 3083 women were included in survival analyses. Data were extracted from the hospital-based cancer registry. Overall survival (OS) was defined as the time from diagnosis to death from any cause or last known contact and was estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to identify predictors of mortality. Results: Median OS was 15.5 months (95% CI: 14.3-17.1). Survival rates were 82.4%, 65.8%, and 52.1% at 6, 12, and 24 months, respectively. Most patients were diagnosed at advanced stages, with 60.1% presenting with FIGO Stage IV disease, and 47.1% received palliative care only. Increased mortality was independently associated with anemia (AHR = 1.60; 95% CI: 1.45-1.76), menopausal status (AHR = 1.17; 95% CI: 1.04-1.32), lower educational attainment (no formal education: AHR = 1.47; 95% CI: 1.20-1.80; primary education: AHR = 1.57; 95% CI: 1.23-2.00), and advanced disease stage. Women diagnosed with FIGO Stage IV disease had the highest mortality risk (AHR = 4.95; 95% CI: 3.53-6.94). Compared with palliative care, radiotherapy alone, chemotherapy alone, radiotherapy plus chemotherapy, and multimodal treatment were associated with lower mortality. Conclusion: Among women receiving care at a major referral center in Mali, OS remained poor and was strongly associated with disease stage at diagnosis, anemia, and socioeconomic factors. Expanding early detection, improving access to specialized cancer care, and strengthening supportive services may contribute to improved survival outcomes.