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Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Little data exist about the clinical management and survival of elderly patients with endometrial cancer. This study aimed to evaluate the management of elderly and very elderly patients with endometrial cancer as well as the overall survival (OS) rate, disease-free survival (DFS) rate, and cancer-specific survival (CSS) rate in a multicenter cohort.

Methods

Data from 1228 patients with endometrial cancer who received primary treatment between January 2001 and December 2012 were collected from a multicenter database. Clinical management, DFS, CSS, and OS were analyzed.

Results

Based on the international endometrial cancer risk classification, 36% (212/582) of women age 65 years or younger, 42% (220/526) of women ages 65–80 years, and 48% (58/120) of women older than 80 years showed high-risk endometrial cancer (p < 0.001). Pelvic lymphadenectomy was performed for 85% (230/271) of the women age 65 years or younger and 46% (33/71) of the women older than 80 years (p < 0.001). Radiotherapy was performed for 27% (33/120) of the very elderly and 40% (233/582) of the young patients (p = 0.009). The 3-year CSS rates were 95% (95% confidence interval [CI], 93–97%) for the women age 65 years or younger, 90% (95% CI, 87–94%) for the women ages 65–80 years, and 82% (95% CI, 73–93%) for the women older than 80 years (p < 0.001).

Conclusions

The elderly and very elderly patients with endometrial cancer showed poorer prognosis than young patients. The significant lower CSS rate for the elderly patients could have be due to both the higher rate of high-risk endometrial cancer and undertreatment. Specific guidelines for the management of elderly and very elderly patients with endometrial cancer are needed to improve their prognosis.

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References

  1. Reis L, Eisner M, Kosary C, et al. SEER Cancer Statistics Review, 1975–2000. National Cancer Institute, Bethesda; 2003.

    Google Scholar 

  2. U.S. Census Bureau. The 65 Years and Overpopulation: 2000. Released October 2001 at http://www.census.gov/prod/2001pubs/c2kbr01-10.pdf.

  3. Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol. 2001;19:666–75.

    Article  CAS  PubMed  Google Scholar 

  4. Lewis JH, Kilgore ML, Goldman DP, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–9.

    Article  PubMed  Google Scholar 

  5. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.

    Article  CAS  PubMed  Google Scholar 

  6. Yee KW, Pater JL, Pho L, Zee B, Siu LL. Enrollment of older patients in cancer treatment trials in Canada: why is age a barrier? J Clin Oncol. 2003;21:1618–23.

    Article  PubMed  Google Scholar 

  7. Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA. Representation of older patients in cancer treatment trials. Cancer. 1994;74:2208–14.

    Article  CAS  PubMed  Google Scholar 

  8. Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on US cancer burden. Cancer. 2002;94:2766–92.

    Article  PubMed  Google Scholar 

  9. Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.

    Article  PubMed  Google Scholar 

  10. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–36.

    Article  PubMed  Google Scholar 

  11. Siegel R, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2015;65:5–29.

    Article  PubMed  Google Scholar 

  12. Mikuta JJ. International federation of gynecology and obstetrics staging of endometrial cancer 1988. Cancer. 1993;71:1460–3.

    Article  CAS  PubMed  Google Scholar 

  13. Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2013;24(Suppl 6):vi33–8.

  14. Bendifallah S, Canlorbe G, Collinet P, et al. Just how accurate are the major risk stratification systems for early-stage endometrial cancer? Br J Cancer. 2015;112:793–801.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Group SGOCPECW, Burke WM, Orr J, et al. Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol. 2014;134:393–402.

  16. Group SGOCPECW, Burke WM, Orr J, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014;134:385–92.

  17. Zeng XZ, Lavoue V, Lau S, et al. Outcome of robotic surgery for endometrial cancer as a function of patient age. Int J Gynecol Cancer. 2015;25:637–44.

    Article  PubMed  Google Scholar 

  18. Setiawan VW, Yang HP, Pike MC, et al. Type I and II endometrial cancers: have they different risk factors? J Clin Oncol. 2013;31:2607–18.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Uccella S, Bonzini M, Palomba S, et al. Laparoscopic vs open treatment of endometrial cancer in the elderly and very elderly: an age-stratified multicenter study on 1606 women. Gynecol Oncol. 2016;141:211–7.

    Article  PubMed  Google Scholar 

  20. Scribner DR Jr, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS. Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible? Gynecol Oncol. 2001;83:563–8.

    Article  PubMed  Google Scholar 

  21. Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311:2110–20.

    Article  CAS  PubMed  Google Scholar 

  22. Ballester M, Dubernard G, Lecuru F, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early-stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76.

    Article  PubMed  Google Scholar 

  23. Singletary SE, Allred C, Ashley P, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 2002;20:3628–36.

    Article  PubMed  Google Scholar 

  24. Briet JM, Hollema H, Reesink N, et al. Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol. 2005;96:799–804.

    Article  PubMed  Google Scholar 

  25. Querleu D, Planchamp F, Narducci F, et al. Clinical practice guidelines for the management of patients with endometrial cancer in France: recommendations of the Institut National du Cancer and the Societe Francaise d’Oncologie Gynecologique. Int J Gynecol Cancer. 2011;21:945–50.

    Article  PubMed  Google Scholar 

  26. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet. 2009;105:103–4.

    Article  PubMed  Google Scholar 

  27. Bourgin C, Saidani M, Poupon C, et al. Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol. 2016;42:166–75.

    Article  CAS  PubMed  Google Scholar 

  28. De Marzi P, Ottolina J, Mangili G, et al. Surgical treatment of elderly patients with endometrial cancer (≥65 years). J Geriatr Oncol. 2013;4:368–73.

    Article  PubMed  Google Scholar 

  29. Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.

    Article  PubMed  Google Scholar 

  30. Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387:1094–108.

    Article  PubMed  Google Scholar 

  31. Koskas M, Rouzier R, Amant F. Staging for endometrial cancer: the controversy around lymphadenectomy—can this be resolved? Best Pract Res Clin Obstet Gynaecol. 2015;29:845–57.

    Article  PubMed  Google Scholar 

  32. Raimond E, Ballester M, Hudry D, et al. Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: results of a retrospective multicenter study. Gynecol Oncol. 2014;133:506–11.

    Article  PubMed  Google Scholar 

  33. Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.

    Article  PubMed  Google Scholar 

  34. Clark LH, Jackson AL, Gehrig PA, Bae-Jump V, Van Le L, Ko EM. Adjuvant treatment and clinical trials in elderly patients with endometrial cancer: a time for change? Int J Gynecol Cancer. 2016;26:282–9.

    Article  PubMed  Google Scholar 

  35. Truong PT, Kader HA, Lacy B, et al. The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer. Am J Clin Oncol. 2005;28:157–64.

    Article  PubMed  Google Scholar 

  36. Rauh-Hain JA, Pepin KJ, Meyer LA, et al. Management for elderly women with advanced-stage, high-grade endometrial cancer. Obstet Gynecol. 2015;126:1198–206.

    Article  PubMed  Google Scholar 

  37. Magne N, Mancy NC, Chajon E, et al. Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol. 2009;91:197–201.

    Article  PubMed  Google Scholar 

  38. Ikushima H, Takegawa Y, Osaki K, et al. Radiation therapy for cervical cancer in the elderly. Gynecol Oncol. 2007;107:339–43.

    Article  PubMed  Google Scholar 

  39. Hamilton CA, Cheung MK, Osann K, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94:642–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Greggi S, Mangili G, Scaffa C, et al. Uterine papillary serous, clear cell, and poorly differentiated endometrioid carcinomas: a comparative study. Int J Gynecol Cancer. 2011;21:661–7.

    Article  PubMed  Google Scholar 

  41. Bosse T, Peters EE, Creutzberg CL, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer: a pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015;51:1742–50.

    Article  PubMed  Google Scholar 

  42. Robinson TN, Eiseman B, Wallace JI, et al. Redefining geriatric preoperative assessment using frailty, disability, and comorbidity. Ann Surg. 2009;250:449–55.

    PubMed  Google Scholar 

  43. Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29:3457–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Hurria A, Mohile S, Gajra A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34:2366–71.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lecuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39:81–6.

    Article  CAS  PubMed  Google Scholar 

  46. Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.

    Article  PubMed  Google Scholar 

  47. Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118:3377–86.

    Article  PubMed  Google Scholar 

  48. Dumas L, Ring A, Butler J, Kalsi T, Harari D, Banerjee S. Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev. 2016;50:99–108.

    Article  PubMed  Google Scholar 

  49. Huisman MG, Kok M, de Bock GH, van Leeuwen BL. Delivering tailored surgery to older cancer patients: preoperative geriatric assessment domains and screening tools: a systematic review of systematic reviews. EJSO. 2016

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Acknowledgement

The authors thank the American Journal Expert for the editing of the manuscript.

Disclosures

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. CHU de Rennes, Service de Gynécologie, Hopital sud, Rennes, France

    Clothilde Poupon MD, Jean Levêque MD, PhD & Vincent Lavoue MD, PhD

  2. Université de Rennes 1, Rennes, France

    Clothilde Poupon MD, Jean Levêque MD, PhD & Vincent Lavoue MD, PhD

  3. Oncogenesis, Stress and Signaling, CRLCC Eugène Marquis, Rennes, France

    Clothilde Poupon MD, Sofiane Bendifallah MD, PhD, Jean Levêque MD, PhD & Vincent Lavoue MD, PhD

  4. Department of Gynaecology and Obstetrics, Institut Universitaire de Cancérologie (IUC), Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Paris, France

    Sofiane Bendifallah MD, PhD, Geoffroy Canlorbe MD, PhD, Emile Daraï MD, PhD & Marcos Ballester MD, PhD

  5. INSERM UMR_S_707, EpidemiologyInformation SystemsModeling, University Pierre and Marie Curie, Paris 6, Paris, France

    Sofiane Bendifallah MD, PhD

  6. Department of Obstetrics and Gynaecology, Centre hospitalier régional universitaire de Tours, Hôpital Bretonneau, Tours, France

    Lobna Ouldamer MD, PhD

  7. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France

    Emilie Raimond MD & Olivier Graesslin MD, PhD

  8. Centre de Lutte Contre le Cancer Georges François Leclerc, Dijon, France

    Nina Hudry MD & Charles Coutant MD, PhD

  9. Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France

    Cyril Touboul MD, PhD

  10. Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France

    Pierre Collinet MD, PhD

  11. Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, Villetaneuse, France

    Alexandre Bricou MD

  12. Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France

    Cyrille Huchon MD, PhD

  13. INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, Paris, France

    Emile Daraï MD, PhD & Marcos Ballester MD, PhD

  14. Service de Gynécologie, CHU de Rennes, Rennes, France

    Vincent Lavoue MD, PhD

Authors
  1. Clothilde Poupon MD
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  2. Sofiane Bendifallah MD, PhD
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  3. Lobna Ouldamer MD, PhD
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  4. Geoffroy Canlorbe MD, PhD
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  6. Nina Hudry MD
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  8. Olivier Graesslin MD, PhD
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  9. Cyril Touboul MD, PhD
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  10. Pierre Collinet MD, PhD
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  12. Cyrille Huchon MD, PhD
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  13. Emile Daraï MD, PhD
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  14. Marcos Ballester MD, PhD
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  15. Jean Levêque MD, PhD
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  16. Vincent Lavoue MD, PhD
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Corresponding author

Correspondence to Vincent Lavoue MD, PhD.

Additional information

FRANCOGYN—Groupe Français de Recherche en Chirurgie Oncologique et Gynécologique.

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Poupon, C., Bendifallah, S., Ouldamer, L. et al. Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group. Ann Surg Oncol 24, 1667–1676 (2017). https://doi.org/10.1245/s10434-016-5735-9

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  • DOI: https://doi.org/10.1245/s10434-016-5735-9

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