1
|
Shim SH, Lim J, Kim JH, Lee YJ, Ha HI, Lim MC, Won YJ. Trends in the incidence and survival outcomes of endometrial cancer in Korea: a nationwide population-based cohort study. J Gynecol Oncol 2024; 35:e32. [PMID: 38130136 PMCID: PMC11107270 DOI: 10.3802/jgo.2024.35.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/23/2023] [Accepted: 11/26/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To evaluate trends in the incidence and survival outcomes of endometrial cancer (EC) based on the year of diagnosis, stage, age, and histologic types. METHODS Women with primary EC diagnosed between 1999 and 2018, and who were followed up with until 2019, were identified from the Korea Central Cancer Registry using the International Classification of Diseases, 10th revision. The age-standardized rates (ASRs) of incidence, annual percent changes (APCs), and survival were estimated according to age, stage, histology, and year of diagnosis. RESULTS The ASR for EC increased from 2.38 per 100,000 in 1999 to 7.29 per 100,000 in 2018 across all histologic types (APCs of 9.82, 15.97, and 7.73 for endometrioid, serous, and clear cell, respectively, p<0.001). There were significant differences in the 5-year survival rates based on histology (90.9%, 55.0%, and 68.5% for endometrioid, serous, and clear cell, respectively, p<0.001), stage (93.4%, 77.0%, and 31.0% for localized, regional, and distant, respectively, p<0.001), and age (93.0% for <50 years and 80.6% for ≥50 years, p<0.001). The 5-year survival was significantly better in the group diagnosed between 2000 and 2018 (85.9%) than that in the 1999-2008 group (83.3%) (p<0.001). This trend was only observed for endometrioid cancer (p<0.001). CONCLUSION The incidence of EC increased across the all 3 subtypes. Survival of patients with endometrioid histology improved over the past two decades, but remained static for serous or clear cell histology. Healthcare strategies to prevent EC incidence in at-risk populations and apply effective treatments for high-risk histology are needed.
Collapse
Affiliation(s)
- Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea
| | - Jiwon Lim
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
| | - Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Yeon Jee Lee
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
- Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
| | - Young-Joo Won
- Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.
| |
Collapse
|
2
|
Giannini A, D'Oria O, Corrado G, Bruno V, Sperduti I, Bogani G, Laganà AS, Chiantera V, Caserta D, Vizza E. The role of L1CAM as predictor of poor prognosis in stage I endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:789-799. [PMID: 37454351 DOI: 10.1007/s00404-023-07149-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Molecular and genomic profiling in endometrial cancer is increasing popularity. L1 cell adhesion molecule (L1CAM) is frequently mutated in endometrial cancer. In this paper, we aim to evaluate the prognostic role of L1CAM in patients with stage I endometrial cancer. METHODS We performed a systematic review and meta-analysis searching in PubMed (MEDLINE), EMBASE, and Web of Science database to identify studies reporting the expression of L1CAM in endometrial cancer. The primary endpoint measure was to assess and evaluate the impact of L1CAM on survival outcomes. This study was performed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. RESULTS Five studies were included. The pooled results suggested that L1CAM expression influences survival outcomes in stage I endometrial cancer. High L1CAM expression correlated with worse disease-free survival (HR 4.11, 95% CI 1.02-16.59, p = 0.047) and overall survival (HR 3.62, 95% CI 1.32-9.31, p = 0.012). High L1CAM level was also associated with a more aggressive FIGO grade and with older age. CONCLUSION This systematic review supported that L1CAM have a prognostic role in stage I endometrial cancer, thus providing a potential useful tool for tailoring the need of adjuvant therapy.
Collapse
Affiliation(s)
- Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy.
| | - Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in "Translational Medicine and Oncology", Sapienza University, Rome, Italy
| | - Giacomo Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| | - Isabella Sperduti
- Scientific Direction, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giorgio Bogani
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Donatella Caserta
- Gynecology Division, Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCSS-Regina Elena National Cancer Unit Institute, Rome, Italy
| |
Collapse
|
3
|
The preoperative G8 geriatric screening tool independently predicts survival in older patients with endometrial cancer: results of a retrospective single-institution cohort study. J Cancer Res Clin Oncol 2023; 149:851-863. [PMID: 35212815 PMCID: PMC9931812 DOI: 10.1007/s00432-022-03934-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this retrospective study was to evaluate the prognostic impact of global health status assessment tools in elderly patients with endometrial cancer (EC) on survival. METHODS Preoperative frailty status was assessed by the G8 geriatric screening tool (G8 Score), Lee Schonberg prognostic index, Charlson Comorbidity index and American Society of Anesthesiologists Physical Status System in women older than 60 years with EC. Univariable and multivariable Cox-regression analyses, as well as Kaplan-Meier survival analyses were performed to determine the prognostic impact. Statistical analyses were adjusted for cancer entity-specific risk factors such as conventional histopathological tumor characteristics and relevant anamnestic life style parameters. RESULTS 153 patients with all stages of EC who were operated at the University Medical Center Mainz between 2008 and 2019 were included. In multivariable analyses, only the G8 Score retained independent significance as a prognostic factor for disease-specific survival (DSS) (HR:4.58; 95% CI [1.35-15.51]) and overall survival (OS) (HR:2.89; 95% CI [1.31-6.39]. 92 patients (61.3%) were classified as G8-non-frail with a significantly increased DSS and OS rate compared to the 58 G8-frail patients (DSS:93.8% vs. 60.8%; p < 0.001 and OS:88.2% vs. 49.7%; p < 0.001; respectively). CONCLUSIONS This is the first study demonstrates the substantial clinical and prognostic impact of the G8 Score on survival in elderly women with EC. Assessing the frailty status to estimate the individual vulnerability of elderly cancer patients could be useful in preoperative decision-making to individualize treatment plans such as the surgical radicality and to improve pre- and postoperative morbidity.
Collapse
|
4
|
González Villa I, González Dávila EF, Afonso IJE, Blanco LIM, Ferrer JFL, Galván JJC. An effective algorithm to detect the possibility of being MSI phenotype in endometrial cancer given the BMI status and histological subtype: a statistical study. Clin Transl Oncol 2022; 24:1809-1817. [PMID: 35511397 PMCID: PMC9338113 DOI: 10.1007/s12094-022-02837-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/05/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE In endometrial cancer, the incidence of mutations in mismatch repair genes (MMR) is estimated at 17-30%. Patients with alterations at this level (MSI) are known to have different clinical and anatomopathological characteristics than those without this genetic alteration (MSS). In this study, we aim to identify the MSI phenotype in patients who underwent hysterectomy for endometrial cancer. We assessed the correlation of this phenotype with anatomoclinical parameters such as obesity and histological subtype. METHODS/PATIENTS Clinical and anatomopathological data were collected from 147 patients diagnosed with endometrial cancer and an immunohistochemical study of MMR system proteins was performed. PMS2 and MSH6 proteins were evaluated as primary screening and subsequent evaluation of MLH1 and MSH6, respectively, if the former were negative. Statistical association between the anatomopathological data and the immunohistochemical result was analyzed. RESULTS AND CONCLUSIONS 22.4% of our patients were MSI phenotype. We obtained statistically significant differences by multivariate analysis between endometrioid subtype and higher FIGO classification grade with MSI phenotype and obesity with MSS phenotype. Given these statistical results, we propose a function for predicting the probability of being MSI phenotype taking into account the histological subtype (endometrioid/non-endometrioid carcinoma) and FIGO grade as well as obesity. This prediction may be useful prior to hysterectomy, for genetic study of the MLH1 promoter and subsequent genetic counseling.
Collapse
Affiliation(s)
- Isabel González Villa
- Pathological Anatomy Service, Canary University Hospital, Tenerife, Spain
- Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Idaira Jael Expósito Afonso
- Pathological Anatomy Service, Nuestra Señora de Candelaria University Hospital, Canary Islands Health Service, Tenerife, Spain
| | - Leynis Isabel Martínez Blanco
- Pathological Anatomy Service, Nuestra Señora de Candelaria University Hospital, Canary Islands Health Service, Tenerife, Spain
| | - Juan Francisco Loro Ferrer
- Department of Clinical Sciences, Faculty of Health Sciences, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Juan José Cabrera Galván
- Pathological Anatomy Unit, Morphology Department, University Institute for Biomedical and Health Research (IUIBIS), University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| |
Collapse
|
5
|
Ibrahim AH, Abd El Wahab MH, Shash E. Quality of Life and Endometrial Cancer. HANDBOOK OF QUALITY OF LIFE IN CANCER 2022:425-437. [DOI: 10.1007/978-3-030-84702-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
6
|
Postoperative Radiotherapy for Endometrial Cancer in Elderly (≥80 Years) Patients: Oncologic Outcomes, Toxicity, and Validation of Prognostic Scores. Cancers (Basel) 2021; 13:cancers13246264. [PMID: 34944884 PMCID: PMC8699803 DOI: 10.3390/cancers13246264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 01/23/2023] Open
Abstract
Endometrial cancer is a common malignancy in elderly women that are more likely to suffer from limiting medical comorbidities. Given this narrower therapeutic ratio, we aimed to assess the oncologic outcomes and toxicity in the adjuvant setting. Out of a cohort of 975 women, seventy patients aged ≥ 80 years, treated with curative postoperative radiotherapy (RT) for endometrial cancer between 2005 and 2021, were identified. Outcomes were assessed using Kaplan-Meier-analysis and comorbidities using the Charlson Comorbidity Index and G8 geriatric score. The overall survival at 1-, 2- and 5-years was 94.4%, 82.6%, and 67.6%, respectively, with significant correlation to G8 score. At 1- and 5-years, the local control rates were 89.5% and 89.5% and distant control rates were 86.3% and 66.9%, respectively. Severe (≥grade 3) acute toxicity was rare with gastrointestinal (2.9%), genitourinary (1.4%), and vaginal disorders (1.4%). Univariate analysis significantly revealed inferior overall survival with lower RT dose, G8 score, hemoglobin levels and obesity, while higher grading, lymphangiosis, RT dose decrease and the omission of chemotherapy reduced distant control. Despite older age and additional comorbidities, elderly patients tolerated curative treatment well. The vast majority completed treatment as planned with very low rates of acute severe side-effects. RT offers durable local control; however, late distant failure remains an issue.
Collapse
|
7
|
Yu Z, Wei S, Zhang J, Shi R, An L, Feng D, Wang H. Development and Validation of a Novel Prognostic Model for Endometrial Cancer Based on Clinical Characteristics. Cancer Manag Res 2021; 13:8879-8886. [PMID: 34866940 PMCID: PMC8637423 DOI: 10.2147/cmar.s338861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/17/2021] [Indexed: 12/09/2022] Open
Abstract
Objective Existing prognostic models for endometrial cancer are short of facility and effective validation. In this study, we aim to develop and validate a novel prognostic model for endometrial cancer based on clinical characteristics. Methods The clinical data such as age, BMI (body mass index), FIGO stage, surgical approach, myometrial invasion, grade, lymph node metastasis, pathology and menopause status were collected for constructing and validating the prognostic model from The Cancer Genome Atlas (TCGA) and Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, respectively. COX regression and the least absolute shrinkage and selection operator (LASSO) COX were applied to identify the significant predictors of overall survival (OS) and construct the prognostic model. The discrimination, calibration, and clinical usefulness of the model were evaluated in both cohorts. Results Three hundred and sixty-seven and 286 EC patients were collected for training and validation cohort, respectively. A clinical prognostic model integrating six clinical variables including age, BMI, FIGO stage, surgical approach, myometrial invasion and grade was established. K-M analysis shows a significant difference between the low- and high-risk groups. The area under the receiver operating characteristic curve (AUC-ROC) was 0.775 (95% CI, 0.708 to 0.843) and 0.870 (95% CI, 0.758 to 0.982) for the training and validation cohorts which indicating reliable discrimination. The calibration curve revealed excellent predictive accuracy and the Hosmer–Lemeshow test also verified this. Decision curve analysis (DCA) for the prognostic model indicated that it would add more benefits than either the detect-all-patients scheme or the detect-none scheme. In addition, our model has a superior AUC comparing with any single factor as predicting OS. Conclusion Our predictive model offers a convenient and accurate tool for clinicians to estimate the prognosis of EC patients.
Collapse
Affiliation(s)
- Zhicheng Yu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Sitian Wei
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Jun Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Rui Shi
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Lanfen An
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Dilu Feng
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hongbo Wang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| |
Collapse
|
8
|
Song W, Zhao Y. A prediction model based on clinical and histological features for predicting recurrence in patients with stage I-II endometrial cancer after surgical treatment. Ann Diagn Pathol 2021; 56:151861. [PMID: 34953233 DOI: 10.1016/j.anndiagpath.2021.151861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The study aimed to develop a prediction model combining clinical and histological features to predict recurrence in patients with stage I-II endometrial cancer (EC) after surgical treatment. METHODS A total of 746 stage I-II EC patients who had received primary surgical treatment at Taizhou People's Hospital between 2014 and 2018 were included and randomly divided as a Training cohort (n = 520) and a Validation cohort (n = 226) at a 7:3 ratio. Clinical features including age, body mass index, comorbidities, lymphadenectomy, and adjuvant treatment, and histological features including histologic type, myometrial invasion, cervical stromal invasion, and expression levels of Ki67, estrogen receptor (ER), progesterone receptor (PR), whey acidic protein 4-disulphide core domain 2 (WFDC2), and p53 were used to develop a prediction model for EC recurrence in the Training cohort using a multivariable Cox regression model. Model discrimination and calibration were further evaluated in the Validation cohort. RESULTS EC recurrence was observed in 60 (11.54%) patients in the Training cohort with a median length of follow-up of 39 months. Age, adjuvant treatment, histologic type, cervical stromal invasion, and expression levels of Ki67, ER, PR, and WFDC2 were factors significantly associated with EC recurrence based on univariable Cox regression analysis. After a model selection by AIC in a stepwise algorithm, the final model incorporated the above predictors showed a C-index of 0.85 and fair calibration in the Training cohort. In the Validation cohort, the model still showed good discrimination power (C-index 0.80) but moderate calibration. CONCLUSIONS The developed prediction model combining clinical and histological features can help to predict the EC recurrence in patients with stage I-II EC after surgical treatment.
Collapse
Affiliation(s)
- Weiwei Song
- Department of Traditional Chinese Medicine, Taizhou People's Hospital, Taizhou 225300, China.
| | - Yinling Zhao
- Department of Gynecology, Taizhou People's Hospital, Taizhou 225300, China
| |
Collapse
|
9
|
Prognostic factors of endometrial cancer in elderly patient group and their effects on survival. North Clin Istanb 2021; 8:345-353. [PMID: 34585068 PMCID: PMC8430360 DOI: 10.14744/nci.2020.47154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE: The objective of the study was to investigate the prognostic factors of the elderly group and their effects on survival by examining the histopathological features, surgical treatment protocols, and treatment modalities of patients diagnosed with endometrial cancer (EC). METHODS: The records of 397 EC patients who completed their treatment and follow-up at a single center between 2012 and 2019 were evaluated retrospectively. The patients were evaluated in two groups as <70 years old (n: 301; 75.8%) and >70 years old (n: 96; 24.2%). Following the evaluation of histopathological features and treatment protocols, independent risk factors influencing survival were investigated with the Cox regression model. RESULTS: The incidence of non-endometrioid histology (16.3% vs. 32.3%, p: 0.001), high-grade tumors (50.5% vs. 69.8%; p: 0.001), and >50 myometrial invasion (19.6% vs. 36.5%, p: 0.003) in the >70 age group was more frequent than that in the <70 age group. The independent risk factors on overall survival in the >70 age group were determined as non-endometrioid histology (HR: 5.9; 95% CI: 1.4– 24.7) and lymph node metastasis (HR: 6.4; 95% CI:1.6–25.0). In the <70 age group, non-endometrioid histology (HR: 11.3; 95% CI: 4.0–32.0) was identified as the only independent risk factor affecting 5-year survival. CONCLUSION: EC, with non-endometrioid histology, which is observed at a higher rate in elderly patients despite equal surgery and adjuvant therapy, is the primary factor that affects survival.
Collapse
|
10
|
Sun S, Zou L, Wang T, Liu Z, He J, Sun X, Zhong W, Zhao F, Li X, Li S, Zhu H, Ma Z, Wang W, Jin M, Zhang F, Hou X, Wei L, Hu K. Effect of age as a continuous variable in early-stage endometrial carcinoma: a multi-institutional analysis in China. Aging (Albany NY) 2021; 13:19561-19574. [PMID: 34371481 PMCID: PMC8386535 DOI: 10.18632/aging.203367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/15/2021] [Indexed: 11/27/2022]
Abstract
Objective: To explore the effect of age at diagnosis as a continuous variable on survival and treatment choice of patients with early-stage endometrial carcinoma (EC). Materials and Methods: We retrospectively analyzed data from patients with early-stage EC from January 1999 to December 2015 in multiple institutions in China. All patients received primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy for EC confirmed pathology of stage I and II disease (FIGO 2009 staging). All patients were divided into low-risk, intermediate-risk, high-intermediate-risk and high-risk groups according to ESMO-ESGO-ESTRO risk classification. Results: The median follow-up time was 57months, and the 5-year cancer-specific survival (CSS) was 95.7%. Age as a continuous variable was an independent prognostic factor for CSS. With an increase in age, the hazard ratio (HR) for CSS increases gradually. Other independent prognostic factors included myometrial invasion (MI), grade, and chemotherapy. In the stratified analysis of age, the HRs of age on CSS in patients >70y were 5.516, 5.015, 4.469, 4.618, 5.334, and 5.821 after adjusting for cancer characteristics, local treatment, chemotherapy and treatment-related late toxicity. In patients 66-70-year-old, the HRs were 2.509, 2.074, 2.101, 2.091, 2.157 and 1.621 after adjusting for the above covariates. In patients ≤65y, there was no significant difference in the HR of age on CSS after adjustment. Conclusion: Age as a continuous variable is an independent prognostic factor and 65 year-old may be the best cut-off point for CSS in patients with early-stage EC in the Asian population. Quality of life should be given greater weight in the choice of therapeutic schedule for those patients >70 y.
Collapse
Affiliation(s)
- Shuai Sun
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lijuan Zou
- Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, P.R. China
| | - Tiejun Wang
- Department of Radiation Oncology, The Second Hospital Affiliated by Jilin University, Changchun, P.R. China
| | - Zi Liu
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Jianli He
- Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Ningxia, P.R. China
| | - Xiaoge Sun
- Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, P.R. China
| | - Wei Zhong
- Gynaecological Oncology Radiotherapy, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, P.R. China
| | - Fengju Zhao
- Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, P.R. China
| | - Xiaomei Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, P.R. China
| | - Sha Li
- Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, P.R. China
| | - Hong Zhu
- Department of Radiation Oncology, Xiangya Hospital Central South University, Hunan, P.R. China
| | - Zhanshu Ma
- Department of Radiation Oncology, Affiliated Hospital of Chi feng University, Inner Mongolia, P.R. China
| | - Wenhui Wang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Meng Jin
- Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Fuquan Zhang
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Xiaorong Hou
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Lichun Wei
- Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (The Fourth Military Medical University), Xi'an, P.R. China
| | - Ke Hu
- Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| |
Collapse
|
11
|
Wang H, Shi H. Megestrol acetate drives endometrial carcinoma cell senescence via interacting with progesterone receptor B/FOXO1 axis. Exp Biol Med (Maywood) 2021; 246:2307-2316. [PMID: 34233525 DOI: 10.1177/15353702211026566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Megestrol acetate is a common and efficient anticancer progesterone. To explore the activity and the therapeutic mechanisms of megestrol acetate in endometrial cancer, human endometrial cancer cell lines Ishikawa and HHUA overexpressing progesterone receptor A (PR-A) and progesterone receptor B (PR-B) were treated with megestrol acetate. Cell viability, apoptosis, cycle arrest, and senescence, as well as the expressions of p21 and p16, two hallmarks of cellular senescence, were evaluated. Compared with the control, >10 nmol/L megestrol acetate treatment could significantly reduce endometrial cancer cell growth, and induce the irreversible G1 arrest and cell senescence. The expression of cyclin D1 in megestrol acetate treated cells was downregulated, while the expressions of p21 and p16 were upregulated via PR-B isoform. FOXO1 inhibitor AS1842856 could significantly abrogate megestrol acetate-induced cell senescence, suggesting that FOXO1 was involved in megestrol acetate/PR-B axis. These findings may provide a new understanding for the treatment of human endometrial cancer.
Collapse
Affiliation(s)
- Hong Wang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.,Department of Obstetrics and Gynecology, The Second People's Hospital of Jiaozuo (The First Affiliated Hospital of Henan Polytechnic University), Jiaozuo 454001, China
| | - Huirong Shi
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| |
Collapse
|
12
|
Defining prognostic factors in older patients with endometrial cancer. Ir J Med Sci 2021; 191:1123-1131. [PMID: 34101103 DOI: 10.1007/s11845-021-02663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endometrial cancer (EC) is most frequently seen in older and postmenopausal women. AIM The aim of this study was to evaluate the rate of recurrence and survival and clinical, pathological, surgical, and treatment factors affecting recurrence and survival in older patients with EC. METHODS Three hundred and six (21.7%) patients aged ≥ 65 out of a total of 1413 patients diagnosed with and treated for epithelial EC at the Division of Gynecologic Oncology between January 1993 and May 2013 were evaluated retrospectively. All patients were staged according to FIGO 2009 staging system. Progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were determined. Independent prognostic factors affecting recurrence and survival were evaluated by multivariate logistic regression analysis. RESULTS The median age of the patients was 68 (65-92) years. Eighty-nine patients (29.1%) were diagnosed with stage III-IV disease. Tumor type was endometrioid in 226 (73.9%) patients, and 101 (33%) patients were diagnosed with FIGO grade 1 endometrioid endometrial cancer. One hundred fifty-three patients received adjuvant therapy after surgery. Five-year PFS, 5-year CSS, and 5-year OS were 73%, 85%, and 83%, respectively. Only the 2009 FIGO stage was independently associated with PFS (OR = 3.495, 95% CI 1.592-7.675; p = 0.002) and CSS (OR = 6.135, 95%CI 1.269-31.417; p = 0.024). CONCLUSION In conclusion, 2009 FIGO stage was found to be the only independent prognostic factor associated with recurrence and death in older patients with endometrial cancer.
Collapse
|
13
|
Hachisuga K, Ohishi Y, Tomonobe H, Yahata H, Kato K, Oda Y. Endometrial endometrioid carcinoma, grade 1, is more aggressive in the elderly than in the young. Histopathology 2021; 79:708-719. [PMID: 33982792 DOI: 10.1111/his.14400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this study was to characterise grade 1 (G1) endometrioid carcinoma in the elderly, by using clinicopathological features and immunohistochemical features of surrogate markers of molecular subtypes. METHODS AND RESULTS We retrospectively analysed tumour samples from 268 patients with G1 endometrioid carcinoma (<40 years, n = 24; 40-59 years, n = 169; ≥60 years, n = 75) for whom long-term clinical follow-up data were available. G1 endometrioid carcinoma in the elderly (≥60 years) was characterised by frequent deep myometrial invasion, less frequent endometrioid intraepithelial neoplasia (EIN), lack of benign hyperplasia (BH), less frequent squamous differentiation, and occasional aberrant p53 expression. In contrast, this condition in the young (<40 years) was characterised by frequent EIN, BH, and squamous differentiation. Univariate analysis revealed that elderly status (≥60 years), International Federation of Obstetrics and Gynecology (FIGO) 2009 stage and aberrant p53 expression were significantly associated with shorter progression-free survival, and multivariate analysis revealed that elderly status and FIGO 2009 stage were independently associated with a poor prognosis. CONCLUSIONS G1 endometrioid carcinoma in the elderly is more aggressive than that in the young, and elderly status is an independent predictor of shorter progression-free survival in this condition. We propose that type 1 tumours can be subdivided into type 1a (young age at onset and indolent) and type 1b (old age at onset and relatively aggressive).
Collapse
Affiliation(s)
- Kazuhisa Hachisuga
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiro Ohishi
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Diagnostic Pathology, Iizuka Hospital, Fukuoka, Japan
| | - Hiroshi Tomonobe
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Gynaecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomical Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
14
|
Li Y, Chu C, Hu C. Effects of surgery on survival of patients aged 75 years or older with oral tongue squamous cell carcinomas. Sci Rep 2021; 11:6003. [PMID: 33727684 PMCID: PMC7966770 DOI: 10.1038/s41598-021-85647-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/04/2021] [Indexed: 12/23/2022] Open
Abstract
The objective of this study is to assess prognostic value of surgery for elderly oral tongue squamous cell carcinomas (OTSCC) patients. Patients with OTSCC were extracted from the SEER database between 2010 and 2014. The distributions of categorical demographic and clinicopathological characteristics were determined for different age groups: the 75-79, 80-84, and 85-102 years old groups. Univariate and multivariate analyses were performed to determine the effects of each variable on survival. A total of 1064 patients were analyzed. 75-79 years old patients tended to be male and rate of surgery declined with advancing age (P < 0.001). 75-79 years old patients more frequently presented with advanced stage compared to their older peers (P = 0.002). Compared to surgery groups, the hazard ratios for no surgery groups were 2.856 (95% CI 2.267-3.599; (P < 0.001)) for OS and 3.687 (95% CI 2.561-5.308; (P < 0.001)) for CSS in multivariable analysis. In subgroup analysis, the effect of no surgery was significantly associated with a higher risk of poor CSS in patients aged 75-79 years, 80-84 years and 85-102 years (P < 0.001, respectively). Our results showed that there were a series of factors contributing to poor outcomes in the elderly OTSCC patients, including clinicopathological characteristics and surgical management. Surgical resection is significantly associated with an improved OS and CSS, but further exploration in larger prospective clinical trials and better prognostic and predictive tools for select old patients for surgery are needed.
Collapse
Affiliation(s)
- Yujiao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China
- Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Chu Chu
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Shanghai, China.
| |
Collapse
|
15
|
Evaluation of Prognosticators and Treatment-Related Side Effects in Patients Irradiated Postoperatively for Endometrial Cancer. Cancers (Basel) 2020; 12:cancers12123613. [PMID: 33287244 PMCID: PMC7761733 DOI: 10.3390/cancers12123613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Several trials sought to improve outcomes in endometrial cancer patients with multimodal strategies. Histopathological, clinical, and molecular tumor characteristics were demonstrated to correlate with outcomes. We tested the hypothesis that specific histopathological and clinical parameters are prognosticators for outcomes in patients irradiated postoperatively at our Gynecological Cancer Center. First, we found a significant influence of grading and nodal stage on outcomes. These findings underline the recommendations of more intense treatment in these patient groups, as reflected in current guidelines. Secondly, age had a significant influence on survival be it due to comorbidities and/or due to too hesitant treatment regimen in elderly. Thus, here, it should be aimed at particular treatment strategies. Lastly, we found low rates of side effects associated with brachytherapy and moderate rates of side effects associated with teletherapy. Overall, our study serves as basis for further improvement of treatment strategies and for conceptualization of clinical trials. Abstract Numerous clinical trials sought to improve outcomes in endometrial cancer patients with multimodal treatment strategies. We tested the hypothesis that specific histopathological and clinical parameters are prognosticators for outcomes at our Gynecological Cancer Center. A total of 203 patients (median age, 69.5 years) was included. They were irradiated postoperatively (n = 184: Brachytherapy, n = 19: Teletherapy) between 05/2007 and 03/2020. The median follow-up was 37.2 months. As statistical methods, we used the univariable Cox proportional hazards regression, and log-rank statistics. First, we found a significant influence of grading and nodal stage on outcomes. These findings underline the recommendations of more intense treatment in these patient groups, as already reflected in current guidelines. Secondly, we found that patient age had a significant influence on survival be it due to comorbidities and/or due to too hesitant treatment regimen in the elderly. Thus, it should be aimed at particular strategies in treatment of these patients. Lastly, we found very low rates of treatment-related side effects in patients treated with brachytherapy and moderate rates of side effects in patients treated with teletherapy. Overall, our study serves as basis for further improvement of treatment strategies and for conceptualization of clinical trials.
Collapse
|
16
|
Hag-Yahia N, Gemer O, Eitan R, Raban O, Vaknin Z, Levy T, Leytes S, Lavie O, Ben-Arie A, Amit A, Namazov A, Volodarsky M, Ben-Shachar I, Atlas I, Bruchim I, Kadan Y, Helpman L. Age is an independent predictor of outcome in endometrial cancer patients: An Israeli Gynecology Oncology Group cohort study. Acta Obstet Gynecol Scand 2020; 100:444-452. [PMID: 33090457 DOI: 10.1111/aogs.14015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Advanced age is considered an adverse factor in endometrial cancers but may be a surrogate for other conditions that impact outcomes. The study objective was to assess the association of age with endometrial cancer features, treatment and prognosis. MATERIAL AND METHODS In this multicenter cohort study, consecutive women with endometrial cancer treated at 10 Israeli institutions between 2000 and 2014 were accrued in an assimilated database. Postmenopausal women were stratified into age groups with a cut-off of 80. Clinical, pathological and treatment data were compared using t test or Mann-Whitney test for continuous variables, and Chi-square Test or Fisher's Exact test for categorical variables. Main outcome measures included disease recurrence and disease-specific and overall survival; these were plotted using the Kaplan-Meier method and compared using the log-rank test. The association between age and recurrence and survival, adjusted for other clinical and pathological factors, was assessed using multivariable Cox regression modeling. RESULTS A total of 1764 postmenopausal women with endometrial cancer were identified. Adverse pathological features were more prevalent in older women, including high-risk histologies (35% vs 27%, P = .025), deep myoinvasion (44% vs 29%, P = .001) and lymphovascular involvement (22% vs 15%, P = .024). Surgical staging was performed less frequently among older women (33% vs 56%; P < .001). Chemotherapy was less often prescribed, even for non-endometrioid histologies (72% vs 45%; P < .001). On multivariable analysis, age remained a significant predictor for recurrence (HR = 1.75, P = .007), death of disease (HR = 1.89, P = .003) and death (HR = 2.4, P < .001). CONCLUSIONS Older age in women with endometrial cancer is associated with more adverse disease features, limited surgery and adjuvant treatment, and worse outcomes. On multivariable analysis, age remains an independent prognosticator in this population.
Collapse
Affiliation(s)
- Nasreen Hag-Yahia
- Department of Obstetrics and Gynecology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Ofer Gemer
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Ram Eitan
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Oded Raban
- Department of Obstetrics and Gynecology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Zvi Vaknin
- Department of Obstetrics and Gynecology, Assaf Haroffe Medical Center, Sackler School of Medicine, Tel Aviv University, Zrifin, Israel
| | - Tally Levy
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel
| | - Sofia Leytes
- Department of Obstetrics and Gynecology, Wolfson Medical Center, Sackler School of Medicine, Tel Aviv University, Holon, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Alon Ben-Arie
- Department of Obstetrics and Gynecology, Kaplan Medical Center, Hebrew University, Rehovot, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ahmed Namazov
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Michael Volodarsky
- Department of Obstetrics and Gynecology, Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Ashkelon, Israel
| | - Inbar Ben-Shachar
- Department of Obstetrics and Gynecology, Ziv Medical Center, Bar Ilan University, Zefat, Israel
| | - Ilan Atlas
- Department of Obstetrics and Gynecology, Poriya Medical Center, Bar Ilan University, Tiberias, Israel
| | - Ilan Bruchim
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Rappaport Faculty of Medicine, Technion, Hedera, Israel
| | - Yfat Kadan
- Department of Obstetrics and Gynecology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| | - Limor Helpman
- Department of Obstetrics and Gynecology, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Israel
| |
Collapse
|
17
|
Outcomes of intermediate-risk to high-risk stage I endometrial cancer: 10-year clinical experiences of using in-house multi-channel applicators in a single center. Chin Med J (Engl) 2020; 132:1935-1941. [PMID: 31365429 PMCID: PMC6708688 DOI: 10.1097/cm9.0000000000000382] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are only very few reports on clinical outcomes using multi-channel applicators (MCA) for patients with endometrial cancer (EC) in China. We aimed to evaluate the clinical experience of treating intermediate-risk (IR) to high-risk (HR) stage I EC using in-house made multi-channel applicators (IH-MCA) in a single institution. METHODS Three hundred and ninety patients with stage I IR to HR EC were treated with hysterectomy and adjuvant radiotherapy from 2003 to 2015. All patients received post-operative vaginal cuff brachytherapy (VBT) alone or as a boost after external beam radiotherapy (EBRT). The prescriptions were 500 cGy per fraction for a total of 5 to 6 fractions with brachytherapy alone or 400 to 600 cGy per fraction for 2 to 3 fractions if it was combined with EBRT. Two types of applicators including a traditional rigid IH-MCA and a recent model custom-made with 3 dimension printing technology were used for treatment. The Kaplan-Meier method was used to calculate survival rate. RESULTS Follow-up rate was 92.8% and the median follow-up time was 48 months (range 4-172 months). The 5-year overall survival (OS), progression-free survival, local recurrence, and distant metastasis rates for all patients were 96.3%, 92.1%, 2.9%, and 4.8% respectively. Two patients had isolated relapse in vagina outside the irradiated volume. The univariate and multivariate analysis showed that age and grade were the prognostic factors correlated with OS (hazard ratio: 0.368, 95% confidence interval [CI]: 0.131-1.035, P = 0.048; hazard ratio: 0.576, 95% CI: 0.347-0.958, P = 0.026,). CONCLUSIONS For patients with IR to HR stage I EC, adjuvant VBT alone or in combination with EBRT using IH-MCA led to excellent survival and recurrence rates. Age and grade were the prognostic factors correlated with OS.
Collapse
|
18
|
Mysona DP, Tran LKH, Tran PMH, Gehrig PA, Van Le L, Ghamande S, Rungruang BJ, Java J, Mann AK, Liao J, Kapp DS, Santos BD, She JX, Chan JK. Clinical calculator predictive of chemotherapy benefit in stage 1A uterine papillary serous cancers. Gynecol Oncol 2019; 156:77-84. [PMID: 31796203 DOI: 10.1016/j.ygyno.2019.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Determine the utility of a clinical calculator to predict the benefit of chemotherapy in stage IA uterine papillary serous cancer (UPSC). PATIENTS AND METHODS Data were collected from NCDB from years 2010-2014. Based on demographic and surgical characteristics, a clinical score was developed using the random survival forest machine learning algorithm. RESULTS Of 1,751 patients with stage IA UPSC, 1,012 (58%) received chemotherapy and 739 (42%) did not. Older age (HR 1.06), comorbidities (HR 1.31), larger tumor size (HR 1.27), lymphovascular invasion (HR 1.86), positive peritoneal cytology (HR 2.62), no pelvic lymph node dissection (HR 1.51), and no chemotherapy (HR 2.16) were associated with poorer prognosis. Compared to no chemotherapy, patients who underwent chemotherapy had a 5-year overall survival of 80% vs. 67%. To better delineate those who may derive more benefit from chemotherapy, we designed a clinical calculator capable of dividing patients into low, moderate, and high-risk groups with associated 5-year OS of 86%, 73%, and 53%, respectively. Using the calculator to assess the relative benefit of chemotherapy in each risk group, chemotherapy improved the 5-year OS in the high (42% to 64%; p < 0.001) and moderate risk group (66% to 79%; p < 0.001) but did not benefit the low risk group (84% to 87%; p = 0.29). CONCLUSION Our results suggest a clinical calculator is useful for counseling and personalizing chemotherapy for stage IA UPSC.
Collapse
Affiliation(s)
- D P Mysona
- The University of North Carolina, Chapel Hill, NC, USA; The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - L K H Tran
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - P M H Tran
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - P A Gehrig
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - L Van Le
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - S Ghamande
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - B J Rungruang
- The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - J Java
- Genomics Research Center, University of Rochester Medical Center, Rochester, NY, USA
| | - A K Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - J Liao
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - D S Kapp
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - J X She
- The Medical College of Georgia at Augusta University, Augusta, GA, USA; Jinfinti Precision Medicine, Inc, Augusta, GA, USA.
| | - J K Chan
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA; California Pacific & Palo Alto Medical Foundation/Sutter Health Research Institute, San Francisco, CA, USA.
| |
Collapse
|
19
|
Endometrial cancer in the elderly: does age influence surgical treatments, outcomes, and prognosis? Menopause 2019; 25:968-976. [PMID: 29762198 DOI: 10.1097/gme.0000000000001119] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare clinicopathological characteristics, surgical outcomes, and survival rates for nonelderly (<75 years old) and elderly (≥75 years old) women with endometrial cancer (EC). METHODS This retrospective study included consecutive patients who underwent surgery for EC at the gynecologic-oncologic surgery department of Hôpital Européen Georges-Pompidou (Paris, France) from January, 2002 to December, 2015. Independent-group t tests and chi-square tests were used to compare elderly and nonelderly women. Survival rates were compared using log-rank (Mantel-Cox) tests. RESULTS In the nonelderly and elderly groups, the mean age at EC diagnosis was 63 (range 33-74) and 81 (range 75-95) years, respectively. Compared with nonelderly patients, elderly patients (n = 104) presented with more advanced disease and more aggressive histological findings. However, surgical approaches did not differ between the two groups, and 76% of all patients underwent minimally invasive surgery. Pelvic lymphadenectomy was performed in 65% and 44% of nonelderly and elderly patients, respectively (P = 0.01), whereas para-aortic lymphadenectomy was performed in 26% and 9% of nonelderly and elderly patients, respectively (P < 0.0001). The incidence of perioperative complications was almost the same in the elderly and nonelderly groups. The 5-year disease-free survival rate was higher in the nonelderly group (P = 0.023), and the 5-year cancer-specific mortality rate was higher in the elderly group (P = 0.042). CONCLUSIONS Although elderly patients present with cancers that are more aggressive, the management of EC in this population is not optimal. Further clinical studies need to be conducted for elderly women with EC, and specific treatment guidelines should be developed to improve their prognosis.
Collapse
|
20
|
Ouldamer L, Bendifallah S, Body G, Canlorbe G, Touboul C, Graesslin O, Raimond E, Collinet P, Coutant C, Lavoué V, Lévêque J, Bricou A, Huchon C, Daraï E, Ballester M. Change in hazard rates of recurrence over time following diagnosis of endometrial cancer: An age stratified multicentre study from the FRANCOGYN group. Eur J Surg Oncol 2018; 44:1914-1920. [DOI: 10.1016/j.ejso.2018.07.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/17/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022] Open
|
21
|
Ogane N, Hori SI, Yano M, Katoh T, Kamoshida S, Kato H, Kameda Y, Yasuda M. Preponderance of endometrial carcinoma in elderly patients. Mol Clin Oncol 2018; 9:269-273. [PMID: 30155248 PMCID: PMC6109667 DOI: 10.3892/mco.2018.1680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/16/2018] [Indexed: 11/05/2022] Open
Abstract
Elderly patients with endometrial carcinoma (EMC) are considered to have a poor clinical outcome. The present study included 79 patients aged ≥70 years with EMC stage I or II according to the International Federation of Gynecology and Obstetrics classification, and it was conducted to analyse the clinicopathological significance of histological type (I or II), depth of myometrial invasion (<1/2 or ≥1/2), lymphovascular invasion (+ or -) and immunohistochemical profile. The aim of these analyses was to determine whether these factors may adversely affect the patient outcome and the underlying mechanisms. The immunohistochemical markers used were estrogen receptor (ER), Ki-67 and p53. The expression of these markers was evaluated as high (+) or low (-). Accordingly, the patients were divided into groups as follows: 54 cases type I vs. 25 cases type II; 48 cases with myometrial invasion <1/2 vs. 31 cases without myometrial invasion ≥1/2; 63 cases with lymphovascular invasion vs. 16 cases without lymphovascular invasion; 57 cases with ER (+) vs. 22 cases with ER (-); 24 cases with Ki-67 (+) vs. 55 cases with Ki-67 (-); and 29 cases with p53 (+) vs. 50 cases with p53 (-). In conclusion, close attention must be paid to elderly patients with EMC due to the tumor's intrinsic aggressiveness, which may include the ER (-) and p53 (+) pattern as an independent poor prognostic factor.
Collapse
Affiliation(s)
- Naoki Ogane
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Shin-Ichi Hori
- Department of Gynecology and Obstetrics, Seto Hospital, Tokorozawa, Saitama 359-1128, Japan
| | - Mitsutake Yano
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Tomomi Katoh
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| | - Shingo Kamoshida
- Laboratory of Pathology, Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Hyogo 654-0142, Japan
| | - Hisamori Kato
- Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa 241-8515, Japan
| | - Yoichi Kameda
- Department of Pathology, Kanagawa Prefectural Ashigarakami Hospital, Matsuda, Kanagawa 258-0003, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama 350-1298, Japan
| |
Collapse
|
22
|
Buechel M, McGinnis A, Vesely SK, Wade KS, Moore KN, Gunderson CC. Consideration of older patients for enrollment in phase 1 clinical trials: Exploring treatment related toxicities and outcomes. Gynecol Oncol 2018; 149:28-32. [DOI: 10.1016/j.ygyno.2017.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/17/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
|
23
|
Lancellotta V, Kovács G, Tagliaferri L, Perrucci E, Colloca G, Valentini V, Aristei C. Age Is Not a Limiting Factor in Interventional Radiotherapy (Brachytherapy) for Patients with Localized Cancer. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2178469. [PMID: 29581964 PMCID: PMC5822774 DOI: 10.1155/2018/2178469] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/04/2017] [Accepted: 12/25/2017] [Indexed: 01/23/2023]
Abstract
This review examines the role of interventional radiotherapy (IRT otherwise known as brachytherapy) in cancer treatment for elderly patients. Despite their advanced age and associated comorbidities, elderly patients should receive definitive cancer therapies, including surgery and radiotherapy (RT). In fact, RT becomes first-line option for patients who are not eligible for surgery (due to comorbidities, anticoagulant drugs, and risk of disfigurement) or those who refuse it. It emerged from this review of the literature as effective, simple, safe, and comfortable and was associated with good local control, low toxicity rates, and excellent cosmesis and provided a cost benefit. IRT may be used as sole treatment for small cancers or as a useful adjunct to surgery or external beam radiotherapy (EBRT) in more advanced (or lymph node positive) cases, especially when the aim is local control with adequate preservation of normal tissue function. As palliative treatment, IRT preserves quality of life and/or improves survival. It is to be hoped that this review will serve as a helpful guide for members of multidisciplinary teams that are involved in treating elderly patients with cancer.
Collapse
Affiliation(s)
- Valentina Lancellotta
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - György Kovács
- Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH-CL, Lübeck, Germany
| | - Luca Tagliaferri
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | - Giuseppe Colloca
- Polo Scienze Oncologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Gruppo Italiano di Oncologia Geriatrica (GIOGER), Roma, Italy
| | - Vincenzo Valentini
- Polo Scienze Oncologiche ed Ematologiche, Istituto di Radiologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgery and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| |
Collapse
|
24
|
Torgeson A, Boothe D, Poppe MM, Suneja G, Gaffney DK. Disparities in care for elderly women with endometrial cancer adversely effects survival. Gynecol Oncol 2017; 147:320-328. [DOI: 10.1016/j.ygyno.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/01/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
|
25
|
Driver JA, Viswanathan AN. Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older. Gynecol Oncol 2017; 145:526-530. [PMID: 28359689 DOI: 10.1016/j.ygyno.2017.03.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 03/13/2017] [Accepted: 03/15/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine if readily obtainable markers of frailty predict disease-free survival (DFS) in elderly women with endometrial cancer treated with curative intent. METHODS 88 consecutive women≥age 60 treated with surgery, chemotherapy and radiation for stage I-IV endometrial cancer were included. We considered the following health deficits as markers of "frailty": albumin <3.5mg/dL, hemoglobin <10mg/dL, BMI<20kg/m,2 unintentional weight loss, ECOG performance status ≥2, history of osteopenia or osteoporosis and Charlson comorbidity score. Kaplan-Meier estimates and Cox proportional hazards models of DFS were calculated. RESULTS The median age was 68.5 (range 60-88years). The majority of women (65/88) had at least one frailty factor at baseline and 23/88 had two or more. All women received radiation and chemotherapy. Treatment was delayed, modified or truncated in 46% (40/88) of women due to treatment-related toxicity. Age (< 70 vs. ≥70 y) did not independently predict toxicity or recurrence risk. Women with at least one baseline frailty factor had twice the risk of disease recurrence (HR=2.21;95% CI:1.02-4.80) when adjusted for age, stage, grade and Charlson score. The 3-year DFS was 77% in those with no frailty markers and 48% in those with at least one (p=0.02). The presence of a frailty marker also predicted shortened overall survival (HR=2.34;95% CI:1.08-5.03) irrespective of treatment administered and stage of disease. CONCLUSIONS A combined frailty measure was a more robust predictor of DFS and OS than patient age, tumor characteristics and comorbidities in this cohort of older women with very good functional status.
Collapse
Affiliation(s)
- Jane A Driver
- Geriatric Research Education and Clinical Center, VA Boston Medical Center, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States.
| | - Akila N Viswanathan
- Brigham and Women's Hospital, Boston, MA, United States; Dana-Farber Cancer Institute, Boston, MA, United States; Johns Hopkins School of Medicine, Baltimore, MD, United States
| |
Collapse
|
26
|
Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis. Int J Gynecol Cancer 2017; 27:479-485. [DOI: 10.1097/igc.0000000000000890] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
27
|
Bourgin C, Lambaudie E, Houvenaeghel G, Foucher F, Levêque J, Lavoué V. Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management. Eur J Surg Oncol 2016; 43:703-709. [PMID: 27955835 DOI: 10.1016/j.ejso.2016.10.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the different surgical approaches, perioperative morbidity and surgical staging according to age in patients with endometrial cancer. METHODS Multicentre retrospective study. Cancer characteristics and perioperative data were collected for patients surgically treated for endometrial cancer. The patients were divided into 2 groups according to their age: younger or older than 75 years. RESULTS Surgery was performed on 270 women <75 years old and on 74 ≥ 75 years old. Minimally invasive surgery was performed less often in the elderly compared with their younger counterparts (58.2% vs. 74.8%; p = 0.006). Independently of the surgical approach, the rate of pelvic and para-aortic lymphadenectomy was lower in women older than 75 years old than their younger counterparts (52.7% vs. 74.8%; p < 0.001; 8.1% vs. 21.8%; p = 0.007 respectively). According to the guidelines, more frequent surgical understaging was seen in the elderly compared with the younger (37% vs. 15.2%; p = 0.002). In the comparison of complications for each surgical approach, there was no statistical difference in the ≥75-year-old age group in terms of intra- or postoperative complications between the laparotomy, laparoscopy or robotic surgery group. We found a shorter length of hospital stay for the women who underwent laparoscopy or robotic surgery compared with laparotomy (p < 0.0001). CONCLUSION Elderly women with endometrial cancer are often surgically understaged whereas there is no evidence of greater perioperative complications than for their younger counterparts. They should benefit from minimally invasive surgery and optimal surgical staging to the same extent as younger women.
Collapse
Affiliation(s)
- C Bourgin
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France.
| | - E Lambaudie
- Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France
| | - G Houvenaeghel
- Comprehensive Cancer Centre, Department of Surgical Oncology, Institut Paoli Calmette, 223 Boulevard Ste Marguerite, 13009 Marseille, France
| | - F Foucher
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France
| | - J Levêque
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France
| | - V Lavoué
- Rennes University Hospital, Department of Gynaecology, Hôpital Sud, 16 boulevard de Bulgarie, 35000 Rennes, France; University of Rennes 1, Faculty of Medicine, 2 rue Henri le Guilloux, 35000 Rennes, France; INSERM, ER440, Oncogenesis, Stress and Signaling (OSS), Eugène Marquis Comprehensive Cancer Centre, Rennes, France
| |
Collapse
|
28
|
Isrow D, Burmeister C, Hanna RK, Elshaikh MA. Survival endpoints for young women with early stage uterine endometrioid carcinoma: a matched analysis. Eur J Obstet Gynecol Reprod Biol 2016; 207:115-120. [PMID: 27838535 DOI: 10.1016/j.ejogrb.2016.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/03/2016] [Accepted: 10/21/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Younger age is thought to be a favorable prognostic factor in women with endometrial carcinoma (EC). Survival endpoints were compared between two matched groups of patients with early stage EC: women 45 years or younger and women older than 45 years. METHODS AND MATERIALS Two matched groups of patients were created based on stage, grade, lymph node dissection and adjuvant management. Recurrence-free (RFS), disease-specific (DSS) and overall survival (OS) were calculated. RESULTS A total of 525 patients (88 younger patients and 437 older patients, matched 1:5) were included in this study. The two groups were well balanced except for less myometrial invasion in the younger patients. There were no significant differences between younger and older patients in regards to 5-year RFS (94% vs. 91%, p=0.6902). Similarly, there was no significant difference in regards to DSS (96% vs. 97%, p=0.9000). While 5-year OS was similar for both groups (89% vs. 89%, p=0.9942), 10-year OS was longer in the younger group (83% vs. 68% with p=0.13). On multivariate analysis for RFS, the presence of lymphovascular space invasion was the only predictor of shorter RFS (p=0.0007). Tumor grade (p=0.0002) and lower uterine segment involvement (p=0.0141) were independent predictors of shorter DSS. Older age (p<0.001) and stage II (p=0.01) were the only predictors of shorter OS. CONCLUSIONS When matched based on tumor stage, grade and adjuvant management, our study suggests that there is no difference in survival endpoints between younger and older patients with early stage endometrial carcinoma.
Collapse
Affiliation(s)
- Derek Isrow
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Charlotte Burmeister
- Department of Public Health Science, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Rabbie K Hanna
- Division of Gynecologic Oncology, Department of Women's Health Services, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Mohamed A Elshaikh
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI 48202, USA.
| |
Collapse
|
29
|
Moore KN, Java JJ, Slaughter KN, Rose PG, Lanciano R, DiSilvestro PA, Thigpen JT, Lee YC, Tewari KS, Chino J, Seward SM, Miller DS, Salani R, Moore DH, Stehman FB. Is age a prognostic biomarker for survival among women with locally advanced cervical cancer treated with chemoradiation? An NRG Oncology/Gynecologic Oncology Group ancillary data analysis. Gynecol Oncol 2016; 143:294-301. [PMID: 27542967 PMCID: PMC5693242 DOI: 10.1016/j.ygyno.2016.08.317] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the effect of age on completion of and toxicities following treatment of local regionally advanced cervical cancer (LACC) on Gynecologic Oncology Group (GOG) Phase I-III trials. METHODS An ancillary data analysis of GOG protocols 113, 120, 165, 219 data was performed. Wilcoxon, Pearson, and Kruskal-Wallis tests were used for univariate and multivariate analysis. Log rank tests were used to compare survival lengths. RESULTS One-thousand-three-hundred-nineteen women were included; 60.7% were Caucasian, 15% were age 60-70years and an additional 5% were >70; 87% had squamous histology, 55% had stage IIB disease and 34% had IIIB disease. Performance status declined with age (p=0.006). Histology and tumor stage did not significantly differ. Number of cycles of chemotherapy received, radiation treatment time, nor dose modifications varied with age. Notably, radiation protocol deviations and failure to complete brachytherapy (BT) did increase with age (p=0.022 and p<0.001 respectively). Only all grade lymphatic (p=0.006) and grade≥3 cardiovascular toxicities (p=0.019) were found to vary with age. A 2% increase in the risk of death for every year increase >50 for all-cause mortality (HR 1.02; 95% CI, 1.01-1.04) was found, but no association between age and disease specific mortality was found. CONCLUSION This represents a large analysis of patients treated for LACC with chemo/radiation, approximately 20% of whom were >60years of age. Older patients, had higher rates of incomplete brachytherapy which is not explained by collected toxicity data. Age did not adversely impact completion of chemotherapy and radiation or toxicities.
Collapse
Affiliation(s)
- Kathleen N Moore
- Division of Gynecologic Oncology, Stephenson Oklahoma Cancer Center at the University of Oklahoma, 800 NE 10th Street, Oklahoma City, OK 73121, United States.
| | - James J Java
- NRG Oncology Statistics & Data Management Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Katrina N Slaughter
- Division of Gynecologic Oncology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121, United States.
| | - Peter G Rose
- Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, OH 44109, United States.
| | - Rachelle Lanciano
- Dept. of Radiation Oncology, Crozer Keystone Regional Cancer Center at Broomall, Crozer Keystone Health System, Broomall, PA 19008, United States.
| | - Paul A DiSilvestro
- Division of Gynecologic Oncology, Women & Infants Hospital, Providence, RI 02905, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Yi-Chun Lee
- Division of Gynecologic Oncology, State University of New York Downstate, Brooklyn, NY 11203, United States.
| | - Krishnansu S Tewari
- Division of Gynecologic Oncology, University of California at Irvine, Orange, CA 92868, United States.
| | - Junzo Chino
- Radiation Oncology, Duke University Medical Center, Durham, NC 27710, United States.
| | - Shelly M Seward
- Division of Gynecologic Oncology, Wayne State University/Karmanos Cancer Center, Detroit, MI 48201, United States.
| | - David S Miller
- Division of Gynecologic Oncology, UT Southwestern Medical Center at Dallas, Dallas, TX 75390, United States.
| | - Ritu Salani
- Division of Gynecologic Oncology, Ohio State University Medical Center, Columbus, OH 43210, United States.
| | - David H Moore
- Division of Obstetrics & Gynecology, Franciscan St. Francis Health, Indianapolis, IN 46237, United States.
| | - Frederick B Stehman
- Division of Gynecologic Oncology, Indiana University School of Medicine, Mel and Bren Simon Cancer Center, Indianapolis, IN 46202, United States.
| |
Collapse
|
30
|
Bourgin C, Saidani M, Poupon C, Cauchois A, Foucher F, Leveque J, Lavoue V. Endometrial cancer in elderly women: Which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol 2016; 42:166-75. [DOI: 10.1016/j.ejso.2015.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/13/2015] [Accepted: 11/01/2015] [Indexed: 02/02/2023] Open
|
31
|
Felix AS, Scott McMeekin D, Mutch D, Walker JL, Creasman WT, Cohn DE, Ali S, Moore RG, Downs LS, Ioffe OB, Park KJ, Sherman ME, Brinton LA. Associations between etiologic factors and mortality after endometrial cancer diagnosis: the NRG Oncology/Gynecologic Oncology Group 210 trial. Gynecol Oncol 2015; 139:70-6. [PMID: 26341710 DOI: 10.1016/j.ygyno.2015.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies have analyzed relationships between risk factors for endometrial cancer, especially with regard to aggressive (non-endometrioid) histologic subtypes, and prognosis. We examined these relationships in the prospective NRG Oncology/Gynecologic Oncology Group 210 trial. METHODS Prior to surgery, participants completed a questionnaire assessing risk factors for gynecologic cancers. Pathology data were derived from clinical reports and central review. We used the Fine and Gray subdistribution hazards model to estimate subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations between etiologic factors and cause-specific subhazards in the presence of competing risks. These models were stratified by tumor subtype and adjusted for stage and socioeconomic status indicators. RESULTS Median follow-up was 60months after enrollment (range: 1day-118months). Among 4609 participants, a total of 854 deaths occurred, of which, 582 deaths were attributed to endometrial carcinoma. Among low-grade endometrioid cases, endometrial carcinoma-specific subhazards were significantly associated with age at diagnosis (HR=1.04, 95% CI=1.01-1.06 per year, P-trend) and BMI (class II obesity vs. normal BMI: HR=2.29, 95% CI=1.06-4.98, P-trend=0.01). Among high-grade endometrioid cases, endometrial carcinoma-specific subhazards were associated with age at diagnosis (HR=1.05, 95% CI=1.02-1.07 per year, P-trend<0.001). Among non-endometrioid cases, endometrial carcinoma-specific subhazards were associated with parity relative to nulliparity among serous (HR=0.55, 95% CI=0.36-0.82) and carcinosarcoma cases (HR=2.01, 95% CI=1.00-4.05). DISCUSSION Several endometrial carcinoma risk factors are associated with prognosis, which occurs in a tumor-subtype specific context. If confirmed, these results would suggest that factors beyond histopathologic features and stage are related to prognosis. ClinicalTrials.gov Identifier: NCT00340808.
Collapse
Affiliation(s)
- Ashley S Felix
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - D Scott McMeekin
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - David Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - David E Cohn
- Division of Gynecologic Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Shamshad Ali
- NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Surgical Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mark E Sherman
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
32
|
Risk-adjusted outcomes in elderly endometrial cancer patients: implications of the contrasting impact of age on progression-free and cause-specific survival. Gynecol Oncol 2015; 138:133-40. [PMID: 25895615 DOI: 10.1016/j.ygyno.2015.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/10/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To reexamine the tenet that advanced age independently impacts progression-free and cause-specific survival in patients with endometrial cancer (EC). METHODS Patients undergoing surgery for stages I-IIIC EC between 1999 and 2008 were stratified by age (<70 vs ≥70years). Three propensity score (PS) methods were utilized to adjust for confounding risk factors. The PS, or conditional probability of being ≥70years old, given a patient's baseline covariates, was derived using logistic regression. The Cox proportional hazards models were fit to estimate the effect of age≥70years on outcomes. RESULTS Of 1182 eligible patients, 822 (69.5%) were <70 and 360 (30.5%) were ≥70. Patients ≥70 were more likely to have multiple adverse risk factors. The total standardized difference of these factors was reduced by 74% and 81%, respectively, using PS-stratification and PS-matching analyses. The nonsignificant trend toward an association between progression-free survival and age≥70 in an unadjusted analysis (hazard ratio [HR], 1.40; 95% CI, 0.95-2.04) was further attenuated in the 3 PS analyses. The unadjusted HR for the association between age≥70 and cause-specific survival was 2.03 (95% CI, 1.32-3.13). HRs were attenuated in PS analyses but retained significance (except for PS matching), potentially reflecting differences in salvage therapies (P<.001), including a 3-fold greater use of chemotherapy in those <70. CONCLUSION When risk-adjusted for the higher prevalence of adverse prognostic factors in elderly EC patients, progression-free survival after primary therapy is not age dependent but the less favorable cause-specific survival in this cohort may reflect age-related postrecurrence treatment differences.
Collapse
|
33
|
Tuomi T, Pasanen A, Luomaranta A, Leminen A, Bützow R, Loukovaara M. Risk-stratification of endometrial carcinomas revisited: A combined preoperative and intraoperative scoring system for a reliable prediction of an advanced disease. Gynecol Oncol 2015; 137:23-7. [DOI: 10.1016/j.ygyno.2015.01.545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/21/2015] [Indexed: 11/16/2022]
|
34
|
Bibault JE, Nickers P, Tresch E, Cordoba A, Leblanc E, Comte P, Lacornerie T, Lartigau E. Feasibility study of pelvic helical IMRT for elderly patients with endometrial cancer. PLoS One 2014; 9:e113279. [PMID: 25423024 PMCID: PMC4244154 DOI: 10.1371/journal.pone.0113279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/22/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose Standard treatment for early-stage endometrial cancer involves surgery (when possible) followed by brachytherapy or external-beam radiotherapy (EBRT) for high-risk tumors. EBRT is not without toxicity, meaning that it could be difficult to complete for elderly patients, who typically have decreased reserve and resistance to stressors. Patients and methods Patients aged 70 and over treated between April 2009 and May 2013 for endometrial cancer and received IMRT (Intensity-Modulated Radiation Therapy) were included in this observational study. IMRT could be performed as adjuvant treatment or as an exclusive treatment for patients not amenable to surgery. The primary endpoints of this study were to assess the feasibility and toxicity of pelvic IMRT in this population. Secondary endpoints were to assess disease-specific survival, overall survival, and local control. Predictors of toxicity were also explored. Results Forty seven consecutive patients were included in the analysis. Median age at diagnosis was 75 years (range, 70–89 years). Eleven patients were aged 80 years and older. Toxicities were found in thirty four patients (72%) during treatment. Among these, toxicity did not exceed grade 2 for 32 patients (68%). Two patients had a grade 3 toxicity (4%). Overall survival rates were 87% and 83% at 1 and 2 years, respectively. Six patients (12.8%) had a local relapse and nine others (19.1%) had distant relapse. Conclusions Pelvic helical IMRT for patients aged 70 and older is feasible with full standard radiation doses, showing that age greater than 70 should not be considered as a reason not to perform optimal treatment.
Collapse
Affiliation(s)
- Jean-Emmanuel Bibault
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- Faculty of Medicine, University Lille 2, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Philippe Nickers
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Emmanuelle Tresch
- Biostatistics Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Abel Cordoba
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Eric Leblanc
- Gynaecological Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Pauline Comte
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Thomas Lacornerie
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
| | - Eric Lartigau
- Academic Radiation Oncology Department, Oscar Lambret Comprehensive Cancer Center, 3 rue Frédéric Combemale, Lille, France
- Faculty of Medicine, University Lille 2, Lille, France
- ONCOLille, maison régionale de la recherche Clinique, Lille, France
- * E-mail:
| |
Collapse
|
35
|
Ethnic and geographic variations in corpus uteri cancer burden: evidence based on data from 29 states and the District of Columbia. CI5 IX, X and SEER data (1998-2010). Cancer Causes Control 2014; 25:1197-209. [PMID: 24989841 DOI: 10.1007/s10552-014-0425-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the pattern of corpus uteri cancer (CUC) in individual states of the USA according to ethnicity. METHODS Population-based cancer registries from 29 states and the District of Columbia with information on ethnicity for African-American women (AA) and Caucasian-American women (CA) were extracted from the Cancer Incidence in Five Continents (1998-2002, 2003-2007) and the Surveillance, Epidemiology, and End Results Program (SEER; 2008-2010) databases. Rate ratios (RRs) were calculated with respect to ethnicity, age, state, and region. RESULTS In southern states, AA had a lower CUC burden among women aged <60 years (AA/CA RR = 0.67; 95 % CI 0.64-0.70), whereas it was higher among women aged ≥60 years (AA/CA RR = 1.22; 95 % CI 1.19-1.26). In other regions, the lower CUC burden among AA aged <60 years was true in all states; however, the CUC burden among AA aged ≥60 years was similar to that of CA. Data for the most recent period (2008-2010) indicate that the age-dependent crossover in CUC burden was not anymore restricted to the South, but also occurred in other regions. Overall, women in the South have had the lowest CUC burden compared with that in all other regions, irrespective of ethnicity and age. CONCLUSIONS Significant geographic and ethnic variations in the CUC burden exist in the USA. The incidence of hysterectomy could be a factor underlying the geographic variations in CUC burden and particular attention should be given to older AA in southern states.
Collapse
|
36
|
Adjuvant radiation in early stage, unfavorable histology endometrial carcinoma is associated with improved local control and survival. Gynecol Oncol 2014; 133:250-5. [DOI: 10.1016/j.ygyno.2014.02.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/21/2014] [Accepted: 02/23/2014] [Indexed: 11/21/2022]
|
37
|
Benedetti Panici P, Basile S, Salerno MG, Di Donato V, Marchetti C, Perniola G, Palagiano A, Perutelli A, Maneschi F, Lissoni AA, Signorelli M, Scambia G, Tateo S, Mangili G, Katsaros D, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Crocè C, Mangioni C. Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma. Am J Obstet Gynecol 2014; 210:363.e1-363.e10. [PMID: 24361787 DOI: 10.1016/j.ajog.2013.12.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/12/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses. STUDY DESIGN Survival outcomes of trial patients were analyzed in relation to age (≤65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial. RESULTS Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in ≤65 years and >65 years patients, respectively, P < .0001; 5-y CSS 93.8% and 83.5% in ≤65 years and >65 years patients, respectively, P = .003). Among women ≤65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P = .009 and P = .002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P = .55 and P = .58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis. CONCLUSION Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis.
Collapse
|
38
|
Luomaranta A, Leminen A, Loukovaara M. Prediction of lymph node and distant metastasis in patients with endometrial carcinoma: a new model based on demographics, biochemical factors, and tumor histology. Gynecol Oncol 2013; 129:28-32. [PMID: 23333911 DOI: 10.1016/j.ygyno.2013.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/06/2013] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To develop a model that might predict the probability of lymph node and distant metastasis (stages IIIC-IV) in endometrial carcinoma. METHODS We studied 774 patients with endometrial carcinoma treated in a single institution. Demographic factors, biochemical factors and preoperative tumor characteristics, identified as potential risk factors for advanced carcinoma in unadjusted analyses, were used to create a logistic regression model with lymph node and distant metastasis as the dependent variable. Statistically significant odds ratios in the regression model were rounded to the nearest whole number. These rounded values were the estimated weights for each factor that were summed to generate a score that might predict the probability of stage IIIC-IV carcinoma. RESULTS Biochemical factors and preoperative tumor characteristics predicted lymph node and distant metastasis in the regression model, whereas demographic factors were without effect. The score combining weighted risk factors was: (2 × leukocytosis)+(3 × thrombocytosis)+(7 × elevated CA125)+(4 × high-risk histology). The area under curve (AUC) for this total score was 0.823, with 71.6% sensitivity, 75.2% specificity, 25.9% positive predictive value, and 95.7% negative predictive value, using 6 as cut-point. After excluding stage IV carcinomas from the dataset, the AUC was 0.813 for the total score in predicting nodal involvement (P=0.82 vs. total score in predicting stage IIIC-IV carcinomas in the complete dataset). CONCLUSIONS Based on the high negative predictive value, this prediction model could be applied for identifying patients who may not benefit from lymphadenectomy for endometrial carcinoma staging.
Collapse
Affiliation(s)
- Anna Luomaranta
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
| | | | | |
Collapse
|
39
|
Ouldamer L, Duquesne M, Arbion F, Barillot I, Marret H, Body G. Impact de la prise en charge thérapeutique sur la survie chez les femmes très âgées avec cancer de l’endomètre. ACTA ACUST UNITED AC 2012; 40:759-64. [DOI: 10.1016/j.gyobfe.2012.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 06/12/2012] [Indexed: 10/27/2022]
|
40
|
The prognostic significance of age in surgically staged patients with Type II endometrial carcinoma. Gynecol Oncol 2012; 126:16-9. [PMID: 22507535 DOI: 10.1016/j.ygyno.2012.04.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 04/06/2012] [Accepted: 04/08/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many studies have examined the impact of older age on tumor recurrence and survival after hysterectomy for patients with endometrioid carcinoma. However, there is paucity of data examining the prognostic significance of age in patients with Type II endometrial carcinoma. The study was conducted to determine the prognostic impact of age in this patient population. MATERIALS AND METHODS In this Institutional Review Board (IRB)-approved study, our prospectively-maintained database of 1305 patients with endometrial cancer was reviewed. Seventy-two consecutive patients with serous and clear carcinoma 2009 FIGO stages I-II were identified with at least one year follow-up after surgical staging. Patients with mixed histology and those who received preoperative therapy were excluded. All the patients underwent surgical staging from 1989 to 2009. Their medical records were reviewed. The study cohort was divided into two groups based on their age at hysterectomy (≤ 65 vs. >65). Patient's demographics, pathologic features and treatment-related factors were compared. The impact of age on recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Following univariate analysis, multivariate modeling was done using step-wise Cox proportional hazards analysis to assess the impact of age on clinical outcomes after adjusting for various clinical variables. RESULTS Median follow-up for the study cohort was 45 months (range 13-246). Fifty percent of patients received adjuvant platinum-based chemotherapy and/or adjuvant radiation treatment (RT). Thirty-five patients were older than 65 years (49%) and 37 were ≤ 65 (51%). There were no significant differences between the two groups in regard to race (African American vs Caucasian), FIGO stage, number of lymph nodes dissected, lymphovascular space involvement (LVSI), or adjuvant therapy received. There were more clear cell histology in the younger age group (p=0.035). Patients >65 years old developed more recurrences with a 5-year RFS of 59% compared to 84% for younger patients (p=0.036). The five-year DSS was not statistically different between the two groups (68% vs. 79%, respectively with p=0.313). 5-year OS was significantly shorter in the elderly patients (58% vs. 78% with p=0.014). On multivariate analysis, the presence of LVSI, not receiving RT and age >65 were independent predictors of worse RFS (p=<0.001, 0.005, and 0.040 respectively). CONCLUSION In this study for surgically staged FIGO I-II patients with Type II endometrial carcinoma, age more than 65 years is a significant adverse prognostic factor for tumor recurrence.
Collapse
|
41
|
Diaz-Montes TP, Giuntoli RL. Volume-Based Care among Young Women Diagnosed with Uterine Cancer. ISRN SURGERY 2011; 2011:541461. [PMID: 22203912 PMCID: PMC3236364 DOI: 10.5402/2011/541461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/13/2011] [Indexed: 12/03/2022]
Abstract
Purpose. To characterize volume-based care of uterine cancer among women aged ≤50 years. Methods. The Maryland Health Service Cost Review Commission database was accessed for uterine cancer surgical cases from 1994 to 2005. Cross-tabulations and logistic regression models were used to evaluate for significant associations among volume-based care and other variables comparing women ≤50 years with those aged >50 years. Results. Women ≤50 years comprised 13.6% of the cases. Women ≤50 years were less likely to be managed by high-volume surgeons (31.6% versus 35.1%, P = 0.02). For women ≤50 years, there was a trend toward management at low-volume hospitals (52.0% versus 54.0%, P = 0.22). No deaths were reported among the group of women ≤50 years treated by high-volume providers or at high-volume centers. Women ≤50 years managed by high-volume surgeons had longer length of stay (P < 0.001) and higher adjusted cost of hospital-related care (P < 0.00). Women ≤50 years managed at high-volume centers had higher adjusted cost of hospital-related care (P = 0.01). Conclusion. Primary surgical care of young women with uterine cancer is often performed by low-volume providers.
Collapse
Affiliation(s)
- Teresa P. Diaz-Montes
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA
| | - Robert L. Giuntoli
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA
| |
Collapse
|
42
|
Gayar OH, Robbins JR, Parikh K, Lu M, Buekers T, Munkarah A, Elshaikh MA. Hysterectomy for uterine adenocarcinoma in the elderly: Tumor characteristics, and long-term outcome. Gynecol Oncol 2011; 123:71-5. [DOI: 10.1016/j.ygyno.2011.06.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 06/17/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022]
|
43
|
Morbidity and mortality of surgery for endometrial cancer in the oldest old. Am J Obstet Gynecol 2011; 205:66.e1-8. [PMID: 21507372 DOI: 10.1016/j.ajog.2011.02.067] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/22/2011] [Accepted: 02/24/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Although endometrial cancer commonly occurs in elderly women, little is known about the perioperative outcomes of the oldest women (> 80 years of age) who are treated surgically. STUDY DESIGN We performed an analysis of women ≥ 65 years of age with endometrial cancer who underwent hysterectomy from 1998-2007 and who were registered in the Nationwide Inpatient Sample. RESULTS A total of 25,698 women were identified. Compared with women who were 65-69 years old, women who were ≥ 85 years old were more likely to have perioperative surgical complications (12% vs 17%), postoperative medical complications (24% vs 34%), and a longer length of stay (3 vs 5 days) and to require a transfusion (6% vs 10%; P < .05 for all). The perioperative mortality rate was 0.4% in women who were 65-69 years old compared with 1.6% in women who were ≥ 85 years old (P < .0001). CONCLUSION The morbidity that is associated with surgery for endometrial cancer is significantly higher in women who are > 80 years old, even after medical comorbidities have been considered.
Collapse
|
44
|
Gadducci A, Greco C. The evolving role of adjuvant therapy in endometrial cancer. Crit Rev Oncol Hematol 2011; 78:79-91. [DOI: 10.1016/j.critrevonc.2010.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 02/23/2010] [Accepted: 03/24/2010] [Indexed: 01/09/2023] Open
|
45
|
Wright JD, Lewin SN, Barrena Medel NI, Sun X, Burke WM, Deutsch I, Herzog TJ. Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome. Gynecol Oncol 2011; 122:69-74. [PMID: 21429570 DOI: 10.1016/j.ygyno.2011.02.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite the fact that endometrial cancer commonly occurs in elderly women, little is known about the outcome of the oldest old, those > 80 years of age. We examined the patterns of care and outcome of the oldest old women with endometrial cancer. METHODS An analysis of women > 65 years of age with endometrioid adenocarcinoma of the uterus diagnosed between 1988 and 2006 and registered in the Surveillance, Epidemiology, and End Results database was performed. Patients were stratified by age into the following groups: 65-69, 70-74, 75-79, 80-84, and ≥ 85 years of age. Multivariable logistic regression models were constructed to examine treatment while adjusting for other confounders. Cancer-specific survival was examined using Cox proportional hazards models. RESULTS A total of 37,718 women including 5289 aged 80-84 and 3446 ≥ 85 years of age were identified. Older women had higher grade tumors (p<0.0001) and more advanced stage disease (p<0.0001). After adjusting for tumor characteristics, patients ≥ 85 years of age were less likely to undergo hysterectomy (OR=0.14; 95% CI=0.12-0.16) and lymphadenectomy (OR=0.48; 95% CI=0.44-0.54) and less likely to receive radiation (OR=0.41; 95% CI=0.36-0.46). After adjustment for treatment and prognostic factors, cancer-specific mortality was 53% (HR=1.53; 95% CI=1.39-1.67) greater in women 80-84 and 89% (HR=1.89; 95% CI= 1.71-2.08) greater in those ≥ 85 years of age than in women 65-69 years old. CONCLUSION Women > 80 years of age receive less aggressive care than younger women. Even after adjusting for treatment differences, cancer-specific mortality is higher in the oldest old women.
Collapse
Affiliation(s)
- Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Fleming ND, Lentz SE, Cass I, Li AJ, Karlan BY, Walsh CS. Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma? Gynecol Oncol 2010; 120:189-92. [PMID: 21112078 DOI: 10.1016/j.ygyno.2010.10.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 10/28/2010] [Accepted: 10/31/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prior studies have shown that age ≥70 years is associated with more aggressive non-endometrioid histology and worse survival in endometrial cancer. The purpose of this study is to assess if age is an independent poor prognostic factor in endometrioid histologies. METHODS Under an IRB-approved protocol, we identified patients with surgical stage I to II endometrioid endometrial adenocarcinoma from 1995 to 2008 at two institutions. Patients were divided into two groups based on age at diagnosis: Group A (age 50-69 years) and Group B (age≥70 years). All patients underwent hysterectomy, bilateral salpingoophorectomy, +/-pelvic/aortic lymphadenectomy and adjuvant therapy. Prognostic factors were evaluated by univariate and multivariate analyses. RESULTS We identified 338 patients with stage IA to IIB endometrioid endometrial adenocarcinoma. The median age in Group A was 59 years (range 50-69) and Group B was 75 years (range 70-92). Patients in Group B were more likely to have hypertension (51% vs. 68%, p=0.006) and coronary artery disease (9% vs. 18%, p=0.03). There were no differences in progression-free or disease-specific survival, however, Group B had a worse overall survival (OS) (50.1 vs. 62.6 months, p=0.03). On univariate analysis, age (p=0.04), grade (p=0.006), and coronary artery disease (p=0.01) were associated with worse OS. After adjusting for grade and coronary artery disease, age was no longer a significant variable for OS (p=0.17). CONCLUSIONS After adjusting for other poor prognostic factors, age ≥70 years alone may not be a significant variable affecting overall survival in patients with early stage endometrioid endometrial adenocarcinoma.
Collapse
Affiliation(s)
- Nicole D Fleming
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Women's Cancer Research Institute, Los Angeles, CA 90048, USA
| | | | | | | | | | | |
Collapse
|
47
|
Okuma K, Yamashita H, Kawana K, Nakagawa S, Oda K, Nakagawa K. Advanced age is a significant determinant of poor prognosis in patients treated with surgery plus postoperative radiotherapy for endometrial cancer. J Obstet Gynaecol Res 2010; 36:757-63. [DOI: 10.1111/j.1447-0756.2010.01202.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
48
|
Ahmed A, Zamba G, DeGeest K, Lynch CF. The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992-2002. Gynecol Oncol 2008; 111:35-40. [PMID: 18707756 DOI: 10.1016/j.ygyno.2008.06.026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/16/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Few population-based studies have evaluated surgical treatment and outcomes in elderly patients with endometrial cancer. The National Cancer Institute's SEER, Surveillance, Epidemiology and End Results, Program provides a database to examine this issue. The objective of this study was to determine the extent to which elderly women with endometrial cancer receive surgical treatment and to evaluate the impact of surgery on survival. METHODS Data were obtained from the SEER registries for expanded races from 1992-2002. The inclusion criteria were women ages 50 to 95 with pathologically confirmed endometrial cancer. Cases with multiple primaries were excluded. The data were examined with respect to histology, radiotherapy use, extent of surgery and FIGO stage. The survival data were analyzed using a Cox proportional hazard model. Chi-squared tests were used to examine the extent to which elderly women with endometrial cancer receive surgical treatment, hysterectomy at minimum. Endometrial cancer-specific mortality was analyzed. RESULTS 27,517 women were analyzed with 94% of the cohort receiving surgical treatments. There is a significant trend that suggests elderly women, aged 65+ years at time of endometrial cancer diagnosis, received surgical treatment less often than younger women (p<0.001). The age-adjusted hazard of death was reduced with surgical intervention. After adjustment for stage at diagnosis, histology, and radiotherapy, the hazard ratios for endometrial cancer-specific mortality were decreased when surgery was undertaken. CONCLUSIONS In this population-based study, the poor prognosis associated with advanced age may be in part associated with the decreased frequency of surgical treatment. The reasons need to be further investigated. Continued efforts should be directed at providing surgical treatment for elderly patients with endometrial cancer.
Collapse
Affiliation(s)
- Amina Ahmed
- Department of OB/GYN, Division of Gynecologic Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, USA.
| | | | | | | |
Collapse
|
49
|
Kwon JS, Carey MS, Cook EF, Qiu F, Paszat LF. Addressing Wait Times for Endometrial Cancer Surgery in Ontario. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:982-987. [DOI: 10.1016/s1701-2163(16)32691-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Kwon JS, Carey MS, Goldie SJ, Kim JJ. Cost-effectiveness analysis of treatment strategies for Stage I and II endometrial cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:131-139. [PMID: 17346483 DOI: 10.1016/s1701-2163(16)32387-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Practice patterns vary across Canada with respect to indications for surgical staging and adjuvant radiotherapy in early endometrial cancer. We evaluated the cost-effectiveness of two common strategies for managing early endometrial cancer as part of an Ontario population-based study. METHODS A decision-analytic model (DATA 4.5) was developed for Stage I and II endometrioid-type cancer using empiric data from Ontario. On the basis of preoperative biopsy grade, one of two surgical procedures was selected: (1) hysterectomy and bilateral salpingo-oophorectomy (HBSO) or (2) surgical staging (HBSO and pelvic +/- para-aortic lymphadenectomy). Adjuvant radiotherapy (RT) was administered according to final grade and stage. After HBSO, pelvic RT was indicated for Grades 1 and 2 if Stage IC, IIA with > 50% myometrial invasion (MI), or IIB, and for Grade 3 if Stage IB, IC, IIA, or IIB. After staging, pelvic RT was indicated for Grades 1 and 2 if Stage IIB, and for Grade 3 if Stage IC, IIA with > 50% MI, or IIB. Main outcome measures were quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER). Sensitivity analyses were used to evaluate uncertainty around various parameters. RESULTS The most cost-effective (dominant) strategies were determined for each preoperative grade. For Grade 1, HBSO strongly dominated surgical staging. For Grade 2, neither strategy was dominant; surgical staging had an ICER of $5216 per QALY. For Grade 3, surgical staging strongly dominated HBSO. These results were stable over a wide range of estimates for costs and utilities (i.e., patient preferences for a particular health state). CONCLUSION The most cost-effective treatment strategies for early endometrial cancer in Ontario differ according to preoperative grade.
Collapse
Affiliation(s)
- Janice S Kwon
- Department of Obstetrics and Gynecology, University of Western Ontario, London ON
| | - Mark S Carey
- Department of Obstetrics and Gynecology, University of Western Ontario, London ON
| | - Sue J Goldie
- Department of Health Policy and Management, Harvard School of Public Health, Boston MA
| | - Jane J Kim
- Department of Health Policy and Management, Harvard School of Public Health, Boston MA
| |
Collapse
|