Impact de la prise en charge thérapeutique sur la survie chez les femmes très âgées avec cancer de l’endomètre

Endometrial cancer of the very elderly: Management and survival in the Francogyn population

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.

Analysis of the Impact of Comorbidities on Endometrial Lesions Using the Charlson Comorbidity Index in Western Romania

Background and Objectives: This retrospective study aimed to identify the main comorbidities found in gynecological patients hospitalized for endometrial lesions and to analyze the relationships between these comorbidities and each type of endometrial lesion. The Charlson comorbidity index (CCI) was calculated, thus assessing the patient’s probability of survival in relation to the underlying disease and the existing comorbidities. Materials and Methods: During 2015–2019, 594 cases hospitalized for vaginal bleeding outside of pregnancy were included in the research. For all cases, the frequency of comorbidities was calculated, applying the Cox proportional hazard model, considering the hospitalizations (from the following year after the first outpatient or hospital assessment) as a dependent variable; age and comorbidities were considered as independent variables. Results: Analysis of variance (ANOVA) for mean age of patients enrolled after diagnosis and multiple comparisons (via the Tukey post-hoc test) indicate significant differences (p < 0.05) between the average age for endometrial cancer (EC) and that for the typical endometrial hyperplasia or other diagnoses. The most common comorbidities were hypertension (62.28%), obesity (35.01%), and diabetes (22.89%), followed by cardiovascular disease. An intensely negative correlation (r = −0.715281634) was obtained between the percentage values of comorbidities present in EC and other endometrial lesions. The lowest chances of survival were calculated for 88 (14.81% of the total) patients over 50 years (the probability of survival in the next 10 years being between 0 and 21%). The chances of survival at 10 years are moderately negatively correlated with age (sample size = 594, r = −0.6706, p < 0.0001, 95% confidence interval (CI) for r having values from −0.7126 to −0.6238) and strongly negatively correlated with the CCI (r = −0.9359, p < 0.0001, 95% CI for r being in the range −0.9452 to −0.9251). Conclusions: Using CCI in endometrial lesions is necessary to compare the estimated risk of EC mortality with other medical conditions.

Endometrial cancer in the elderly: does age influence surgical treatments, outcomes, and prognosis?

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.