Is endometrial carcinoma intrinsically more aggressive in elderly patients?

Abstract

BACKGROUNDThe current study was conducted to determine the influence of old age (age ≥ 70 years) on outcome in a group of patients with endometrial carcinoma who were treated with simple hysterectomy followed by adjuvant radiation therapy (RT).METHODSBetween November 1987 and May 2000, 405 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB‐II endometrial carcinoma were treated with postoperative RT. Intravaginal RT alone was given to 77% of patients (median dose, 21grays [Gy] given in 3 fractions). Additional postoperative external beam radiation therapy (EBRT) was given to 23% of patients (median dose, 45 Gy). Eighty‐four patients were age ≥ 70 years and 321 patients were age < 70 years. The two groups were well balanced with regard to race, comprehensive surgical staging, aggressive histology, lymphovascular invasion, lower uterine segment involvement, cervical involvement, and the use of postoperative EBRT. Significantly more patients in the age ≥ 70 years group had other comorbidities such as obesity, diabetes mellitus, or hypertension (P = 0.02) and were found to have deep (> 50%) myometrial invasion (P = 0.008).RESULTSWith a median follow‐up time of 48 months, the 5‐year locoregional control (LRC), disease‐free survival (DFS), and overall survival (OS) rates were 95%, 91%, and 90% respectively. On multivariate analysis, poor LRC was found to be correlated with age ≥ 70 years (P = 0.019) and lymphovascular invasion (P = 0.001). Poor DFS was found to be correlated with age ≥ 70 years (P = 0.03), lymphovascular invasion (P = 0.01), and aggressive histology (P = 0.001). Similarly, poor OS was found to correlate with age ≥ 70 years (P = 0.001), lymphovascular invasion (P = 0.01), aggressive histology (P = 0.01), and cervical involvement (P = 0.02). The same factors that were found to correlate with OS (age ≥ 70 years, lymphovascular involvement, aggressive histology, and cervical involvement) also appeared to correlate with disease‐specific survival (P = 0.03, P = 0.008, P = 0.001, and P = 0.04, respectively). The 5‐year actuarial rates of Radiation Therapy Oncology Group late complications that were ≥ Grade 3 (gastrointestinal tract, genitourinary tract, or vagina) were 3% in both groups.CONCLUSIONSEven when treated in a similar fashion, endometrial carcinoma patients age ≥ 70 years appear to fare worse than younger patients independent of other poor prognostic factors. The rate of complications from adjuvant RT, despite a higher rate of comorbidity in elderly patients, was found to be similar in both age groups. Endometrial carcinoma appears to be intrinsically more aggressive in older patients, thus mandating further improvement in their treatment strategies. Cancer 2003. © 2003 American Cancer Society.

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

“…On retrouve une survie qui diminue avec l'âge é levé (> 80 ans), ce qui est en accord avec les donné es pré existantes de la litté rature [1][2][3][4][5][6]. Les co-morbidité s é tant fré quentes chez les sujets âgé s, les notions de mortalité et de survie doivent être pondé ré es par la probabilité de dé cè s par une cause autre que le cancer.…”

“…L'âge trè s avancé constitue dans la litté rature un facteur reconnu de mauvais pronostic [1][2][3][4][5][6].…”

Recent increase in cancer survival according to age: higher survival in all age groups, but widening age gradient

“…For example, it has been shown that older cancer patients are less likely to be referred to specialist care [23], and to receive definitive therapy, such as surgical treatment [24], chemotherapy [25] or radiation [21] than younger patients. Furthermore, differences in tumor biology and aggressiveness are also likely to play a role for some forms of cancer [26,27].…”

Uterine Cancer in Older Women: What Are Its Distinguishing Characteristics?

“…Так, K. M. Alektiar и соавт. показали, что даже если исключить из исследования пациенток с агрессивными гистологическими типами РТМ и глубокой инвазией в миометрий, 5-летняя без-рецидивная выживаемость все равно будет ниже сре-ди пациенток старше 70 лет по сравнению с младшей возрастной группой (88 против 96 % соответственно, р = 0,096) [28]. Это связано с сопутствующей патоло-гией и неполным выполнением стандарта лечения у по-жилых.…”