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Lavoue V, Raimond E, Ballester M, Carcopino X, Azais H, Kerbage Y, Koskas M, Lecointre L, Huchon C, Touboul C, Ouldamer L. [FRANCOGYN group: A brief history]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:51-54. [PMID: 37839793 DOI: 10.1016/j.gofs.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. METHODS Literature review using PUBMed database with the keyword "FRANCOGYN". OBJECTIVES Describing the constitution of the FRANCOGYN group (a national French research group in Oncological and Gynecological Surgery) and present its current and future development. RESULTS The FRANCOGYN group was formed in December 2015, bringing together over the years more than 17 gynecological and oncological surgical department in France. The group carries out clinical research on gynecological pelvic cancers by constituting retrospective cohorts. Its legitimacy allows it to lead or co-lead the drafting of recommendations for clinical practice in the field of gynecological cancers. It now offers prospective randomized research funded by national grants. CONCLUSION The FRANCOGYN network allows us to propose a national reflection on the surgical management of pelvic cancers in women, resulting in numerous international reference publications.
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Affiliation(s)
- Vincent Lavoue
- Service de gynécologie, Francen institut de recherche en santé, environnement et travail (Irset) - UMR_S 1085, site Hôpital Sud, CHU de Rennes, université de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France.
| | - Emilie Raimond
- Service de gynécologie, CHU de Reims, université de Reims, Reims, France
| | - Marcos Ballester
- Service de gynécologie, Diaconesses, Croix Saint-Simon, Paris, France
| | - Xavier Carcopino
- Service de gynécologie, université de Marseille, AP-HM, Marseille, France
| | - Henri Azais
- Service de gynécologie, hôpital européen Georges-Pompidou, AP-HP, Paris, France
| | - Yohan Kerbage
- Service de gynécologie, université de Lille, Lille, France
| | - Martin Koskas
- Service de gynécologie, hôpital Bichat, AP-HP, Paris, France
| | - Lise Lecointre
- Service de gynécologie, CHU de Strasbourg, Strasbourg, France
| | - Cyrille Huchon
- Service de gynécologie, hôpital Lariboisière, AP-HP, Paris, France
| | - Cyril Touboul
- Service de gynécologie, hôpital Tenon (AP-HP.6) Paris, Sorbonne université, UMRS U938 : biologie et thérapie des cancers, Paris, France
| | - Lobna Ouldamer
- Service de gynécologie, centre hospitalier régional universitaire de Tours, hôpital Bretonneau, université François-Rabelais, unité Inserm 1069, 2, boulevard Tonnelle, 37044 Tours, France
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Martin FA, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Endometrial cancer of the very elderly: Management and survival in the Francogyn population. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1023-1030. [PMID: 36707344 DOI: 10.1016/j.ejso.2023.01.008] [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: 07/12/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We aimed to describe management and survival of patients with endometrial cancer (EC) ≥80 years to identify poor prognosis criteria. METHODS We collected clinical, histologic, surgical and follow-up data for patients with EC ≥ 80 years included in a multicenter French cohort (FRANCOGYN) who underwent primary surgical treatment from 1999 to 2019. The outcomes were overall survival (OS) and disease-free survival (DFS). We performed a descriptive analysis then a survival time analysis and comparison using the Kaplan Meier method and log-rank test. RESULTS Of the 1647 patients with EC who received treatment during the study period, 184 (11.17%) were ≥80 years. The mean age was 84 years (±3.34). Thirty-three patients (25.4%) died during the follow-up period and 26 relapsed (18.4%). Forty-nine patients were lost to follow-up (27.37%). The median follow-up time was 15.3 months (4.9-28.8). The median OS and DFS was 16.4 months (6.3-24.9) and 13.6 months (4.5-26.6), respectively. Eighty-three patients received adjuvant therapy (45.11%), out of 95 who had a formal or relative indication. Four patients received adjuvant chemotherapy (2.6%), out of 61 who had a formal or relative indication. Inappropriate or underuse of chemotherapy was significantly associated with a lower median OS of 12.6 months [3.73-24] versus 17.3 months [7.93-41.77] when performed appropriately (HR = 4.14, CI 95% [1.62-10.56]), and a lower median DFS of 10.83 months [3.73-24] versus 17.3 months [7.93-28.5] (HR = 9.04, CI 95% [2.04-40.12]). CONCLUSION Our results suggest that very elderly patients with EC should receive adjuvant chemotherapy according to the standard care guidelines.
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Affiliation(s)
| | - Ludivine Dion
- Gynecology Department of Rennes Teaching Hospital, France
| | | | | | - Henri Azaïs
- Gynecology Department of Georges Pompidou European Teaching Hospital, AP-HP, France
| | - Sofiane Bendifallah
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Cyril Touboul
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | - Yohann Dabi
- Sorbonne University, Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; Clinical Research Group (GRC) Paris 6: Centre Expert Endométriose (C3E), Sorbonne University (GRC6 C3E SU), France
| | | | - Emilie Raimond
- Gynecology Department of Reims Teaching Hospital, AP-HP, France
| | - Hélène Costaz
- Department of Surgical Oncology, Centre Georges François Leclerc, Comprehensive Cancer Center of Dijon, France
| | - Yohan Kerbage
- Gynecology Department of Lille Teaching Hospital, France
| | - Cyrille Huchon
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Camille Mimoun
- Gynecology Department of Lariboisiere Teaching Hospital, AP-HP, France
| | - Martin Koskas
- Gynecology Department of Bichat Teaching Hospital, AP-HP, France
| | - Cherif Akladios
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Lise Lecointre
- Gynecology Department of Strasbourg Teaching Hospital, France
| | - Geoffroy Canlorbe
- Gynecology Department of La Pitié Salpétrière Teaching Hospital, AP-HP, France
| | - Pauline Chauvet
- Gynecology Department of Clermont Ferrand Teaching Hospital, AP-HP, France
| | - Lobna Ouldamer
- Gynecology Department of Tours Teaching Hospital, AP-HP, France
| | - Jean Levêque
- Gynecology Department of Rennes Teaching Hospital, France
| | - Vincent Lavoué
- Gynecology Department of Rennes Teaching Hospital, France.
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Luzarraga-Aznar A, Teixeira N, Luna-Guibourg R, Español P, Soler-Moreno C, Rovira R. Surgical treatment in older patients with endometrial cancer: A retrospective study. Surg Oncol 2022; 44:101852. [PMID: 36126351 DOI: 10.1016/j.suronc.2022.101852] [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: 05/19/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Older patients (OP) diagnosed with endometrial cancer (EC) are less likely to receive an optimal surgical treatment compared with non-older patients (NOP). This undertreatment along with the presence of more aggressive tumours at diagnosis can explain the worse prognosis of EC in OP. There is limited evidence comparing perioperative outcomes between OP and NOP, and the benefit of applying complex procedures to OP is still controversial. The primary objective of the study was to compare intraoperative and postoperative complications between NOP and OP with EC that underwent primary surgery. Secondary objectives were to compare surgical management and survival rates. METHODS This is a retrospective single-centre observational study including women undergoing surgery for EC between 2010 and 2019. Patients were classified according to age as NOP (younger than 75 years) or OP (75 years or older). Basal characteristics and surgical outcomes of groups were compared using Chi-square, Fisher's exact tests, student T-tests or Mann Whitney tests. Kaplan Meier analysis was used to evaluate survival. RESULTS In total 281 patients underwent primary surgery for EC between 2010 and 2019 in our centre. At diagnosis, 184 patients were younger than 75 years while 97 were 75 and older. No differences were found in disease characteristics. Most of our patients (83,3%) underwent laparoscopic surgery. Pelvic (58,2% vs. 37,1%, p = 0,001) and para-aortic (46,7% vs. 23,7%, p < 0,001) lymphadenectomies were performed more frequently in NOP compared with OP. Rates of intra-operative (6,5% vs. 12,4%, p = 0,116) and post-operative (13,0% vs. 20,6%, p = 0,120) complications were not statistically different between NOP and OP, and neither was the rate of severe complications according to Clavien-Dindo classification (5,4% vs. 8,2% of complications grade III-V respectively, p = 0,387). The 5-year disease-specific survival (DSS) rate tended to be lower in the OP than in the NOP (74,8% vs. 82,5%, p = 0,071). Considering only patients in whom complete surgical staging was performed, OP presented similar DSS to NOP, with comparable complication rate. CONCLUSIONS OP do not present a significantly higher rate of perioperative complications compared to NOP. However, they underwent fewer lymphadenectomies and tended to present poorer DSS. Further studies are needed to standardize the surgical management of these patients.
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Affiliation(s)
- Ana Luzarraga-Aznar
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Natalia Teixeira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Rocío Luna-Guibourg
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain.
| | - Pia Español
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Cristina Soler-Moreno
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
| | - Ramon Rovira
- Department of Gynecology and Obstetrics, Hospital de la Santa Creu i de Sant Pau, C/Sant Quintí 89, 08041, Barcelona, Spain
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Oncologic outcomes in elderly patients who underwent hysterectomy for endometrial cancer: a multi-institutional survey in Kinki District, Japan. Int J Clin Oncol 2022; 27:1084-1092. [PMID: 35287187 DOI: 10.1007/s10147-022-02152-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 02/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The goal of this study is to assess the oncologic outcomes of elderly patients who underwent hysterectomy for endometrial cancer across three variables: hysterectomy approach, lymph node resection, and adjuvant therapy. METHODS Hospital records of patients aged ≥ 70 years who underwent hysterectomy for endometrial cancer were obtained from 19 institutions. Patients were categorized into three risk groups: low, intermediate, and high. In each group, disease-free survival and overall survival were compared according to hysterectomy approach, lymph node resection, and adjuvant therapy using Kaplan-Meier method. Cox regression analysis with a 95% confidence interval was performed to estimate relative risk (RR) of death. RESULTS A total of 1246 patients were included. In the low-risk group, the adjusted RR for death for minimally invasive surgery (MIS) versus laparotomy and lymph node resection versus no lymph node resection were 0.64 (0.24-1.72) and 0.52 (0.24-1.12), respectively. In the intermediate-risk group, the adjusted RR for death for MIS versus laparotomy, lymph node resection versus no lymph node resection, and adjuvant therapy versus no adjuvant therapy were 0.80 (0.36-1.77), 0.60 (0.37-0.98), and 0.89 (0.55-1.46), respectively. In the high-risk group, the adjusted RRs for death for lymph node resection versus no lymph node resection and adjuvant therapy versus no adjuvant therapy were 0.56 (0.37-0.86) and 0.60 (0.38-0.96), respectively. CONCLUSIONS MIS is not inferior to laparotomy in uterine-confined diseases. Lymph node resection improved the outcome for all disease stages and histological types. In contrast, adjuvant therapy improved the outcomes only in high-risk patients.
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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.
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Zhou R, Xu J, He J, Gong Y, Wang H, Linghu H. Topical Application of Pseudomonas aeruginosa-Mannose Sensitive Hemagglutinin (PA-MSHA) for Refractory Lymphatic Leakage Following Lymphadenectomy in Patients with Gynecological Malignancies. Cancer Manag Res 2021; 13:4873-4878. [PMID: 34188540 PMCID: PMC8232861 DOI: 10.2147/cmar.s307700] [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: 02/21/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To observe the feasibility and efficacy of Pseudomonas aeruginosa-mannose sensitive hemagglutinin (PA-MSHA) in refractory lymphatic leakage following lymphadenectomy among patients with gynecological cancers. PATIENTS AND METHODS Ten cases with post-operative massive lymphatic leakage were collected, in which patients failed to respond to conservative treatment. Topical PA-MSHA injection of a single dose (2mL) was performed through drainage tube or transvaginal catheter into pelvic or peritoneal cavity. Drainage volumes and side effects were recorded. RESULTS The incidence of refractory lymphatic leakage following pelvic and para-aortic lymphadenectomy was 2.44% (10/409). All ten patients (100%) had quick recovery and were discharged within 72 hours. Among them, one patient (10%) experienced fever and six patients (60%) experienced abdominal pain, one of which was moderate and relieved by routine analgesic treatment. During 11 (6-38) months of follow-up time, no long-term side effect was observed. CONCLUSION Topical injection of PA-MSHA of a single dose appears a feasible and effective treatment for refractory post-operative lymphatic leakage.
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Affiliation(s)
- Rong Zhou
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jie Xu
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Jingke He
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Yao Gong
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Hui Wang
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
| | - Hua Linghu
- Department of Obstetrics & Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of China
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Racin A, Raimond E, Bendifallah S, Nyangoh Timoh K, Ouldamer L, Canlorbe G, Hudry N, Coutant C, Graesslin O, Touboul C, Collinet P, Bricou A, Huchon C, Koskas M, Ballester M, Daraï E, Levêque J, Lavoue V. Lymphadenectomy in elderly patients with high-intermediate-risk, high-risk or advanced endometrial cancer: Time to move from personalized cancer medicine to personalized patient medicine! Eur J Surg Oncol 2019; 45:1388-1395. [PMID: 30846299 DOI: 10.1016/j.ejso.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 02/02/2019] [Accepted: 02/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Pelvic and paraaortic lymphadenectomy are recommended for women with high-intermediate, high-risk and advanced endometrial cancer (EC). Lymphadenectomy is less frequently performed in elderly patients than in younger patients. We examined the survival of elderly women diagnosed with high-risk EC according to whether lymphadenectomy was performed or not. METHODS We selected women over 70 years with high-intermediate risk, high-risk or advanced EC from a multicenter retrospective cohort of women diagnosed between 2001 and 2013. Multivariate logistic regression models and Cox proportional hazards survival methods for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were used for analyses. RESULTS 71 women had lymphadenectomy and were compared with the 213 who did not. Recurrence was similar in both groups (42% vs 33%, respectively, p = 0.17) but more deaths were reported in the group without lymphadenectomy (38% vs 23%, respectively, p < 0.001). There was no difference in adjuvant treatment in the two groups (17% vs 27%, respectively, p = 0.27). Elderly patients without lymphadenectomy had lower 3-year DFS (56% vs 71%, p = 0.076), CSS (67% vs 85%, p < 0.001) and OS (50% vs 71% p < 0.001). The Cox proportional hazard models showed independently poorer prognosis in women without lymphadenectomy (3.027, 95% CI 1.58-5.81, p < 0.001), histology type 2 (3.46, 95% CI 1.51-7.97, p = 0.003) and lymphovascular space involvement (3.47, 95% CI 1.35-8.98, p = 0.01) on 3-year CSS. CONCLUSION No lymphadenectomy in elderly patients with high-risk or advanced EC is independently associated with poorer prognosis. Elderly patients with EC should benefit from lymphadenectomy when indicated.
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Affiliation(s)
- Adélaïde Racin
- CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France
| | - Emilie Raimond
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France
| | - Sofiane Bendifallah
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France
| | - Krystel Nyangoh Timoh
- CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France
| | - Lobna Ouldamer
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - Geoffroy Canlorbe
- INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France
| | - Nina Hudry
- Center de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Charles Coutant
- Center de lutte contre le cancer Georges François Leclerc, Dijon, France
| | - Olivier Graesslin
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France
| | - Cyril Touboul
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France
| | - Pierre Collinet
- Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France
| | - Alexandre Bricou
- Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, France
| | - Cyrille Huchon
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France
| | - Martin Koskas
- Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France
| | - Marcos Ballester
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - Emile Daraï
- Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France
| | - Jean Levêque
- CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France
| | - Vincent Lavoue
- CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France.
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Diver EJ, Hinchcliff EM, Gockley AA, Melamed A, Contrino L, Feldman S, Growdon WB. Assessment of treatment factors and clinical outcomes in cervical cancer in older women compared to women under 65 years old. J Geriatr Oncol 2018; 9:516-519. [PMID: 29503115 DOI: 10.1016/j.jgo.2018.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/23/2018] [Accepted: 02/16/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aims to understand the treatment patterns and clinical outcomes of older women with cervical cancer compared to younger women. METHODS Women undergoing care for cervical cancer between 2000 and 2013 at two academic institutions were identified. The cohort of older patients was defined as >65 years old at diagnosis. Patient charts were retrospectively reviewed, and clinical variables were extracted. Fisher's exact tests, logistic regression, and Kaplan-Meier analyses were performed. RESULTS From 2000 to 2013 1119 women with cervical cancer were identified. Of these, 191 (17.0%) were >65 years old at the time of diagnosis. Older women were more likely to present with higher stage disease (p < 0.001). Controlling for stage, older women were less likely to undergo surgery during their treatment course (38% versus 70%, p < 0.001) and more likely to undergo radiation (77% versus 52%, p < 0.001), but no more likely to receive chemotherapy (p = 0.34). If they did undergo surgery, older women were less likely to have a pelvic lymph node dissection performed (41% versus 61%, p = 0.04), though the rate of positive pelvic lymph nodes was not different (p = 0.80). Overall survival was decreased in the older cohort (p < 0.001). A multivariate model identified age > 65 (HR 1.76, 95%CI 1.30-2.40), stage (HR 2.77, 95%CI 2.40-3.21), and ever undergoing surgery (HR 0.60, 95%CI 0.44-0.82) as independently associated with overall survival. CONCLUSIONS Women over age 65 with cervical cancer are less likely to undergo surgical management and were observed to have a decreased overall survival, even when controlling for use of surgery and stage of disease.
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Affiliation(s)
- Elisabeth J Diver
- Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA.
| | - Emily M Hinchcliff
- Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Allison A Gockley
- Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Alexander Melamed
- Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Leah Contrino
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Sarah Feldman
- Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | - Whitfield B Growdon
- Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA.
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