Advertisement

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

Published:January 10, 2023DOI:https://doi.org/10.1016/j.ejso.2023.01.008

      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.

      Keywords

      Abbreviations:

      EC (Endometrial Cancer), SENTI-ENDO (Sentinel Node Procedure and Endometrial Cancer), CNGOF (National College of French Obstetricians and Gynecologists), BMI (Body Mass Index), FIGO (Internationel Federation of Gynecology and Obstetrics), ESMO (European Society for Medical Oncology), ESTRO (European SocieTy for Radiotherapy and Oncology), ESGO (European Society for Gynecological Oncology), LVSI (Lymphovascular Space invasion), VBT (Vaginal BrachyTherapy), EBRT (External Beam RadioTherapy), CT (ChemoTherapy), RT (RadioTherapy), HIR (High Intermediate Risk), OS (Overall Survival), DFS (Disease-Free Survival), SD (Standard Deviation), HR (Hazard Ratio), CI (Confidence Interval)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Globocan
        Graph production: global Cancer observatory.
        International Agency for Research on Cancer, 2018 (2018)
        • Defossez G.
        • Le Guyader-Peyrou S.
        • Uhry Z.
        • Grosclaude P.
        • Colonna M.
        • Dantony E.
        • et al.
        Estimations nationales de l’incidence et de la mortalité par cancer en France métropolitaine entre 1990 et 2018. Synthèse. Saint-Maurice.
        Santé publique France, 2019: 20
      1. [a]
        • Colombo N.
        • Creutzberg C.
        • Amant F.
        • Bosse T.
        • González-Martín A.
        • Ledermann J.
        • et al.
        ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up.
        Ann Oncol. 2016; 27 (Jan 1): 16-41
      2. [b]
        • Yancik R.
        Population aging and cancer: a cross-national concern.
        Cancer J. 2005; 11 (Dec): 437-441
        • Rauh-Hain J.A.
        • Pepin K.J.
        • Meyer L.A.
        • Clemmer J.T.
        • Lu K.H.
        • Rice L.W.
        • et al.
        Management for elderly women with advanced-stage, high-grade endometrial cancer.
        Obstet Gynecol. 2015 Dec; 126: 1198-1206
        • Sant M.
        • Chirlaque Lopez M.D.
        • Agresti R.
        • Sánchez Pérez M.J.
        • Holleczek B.
        • Bielska-Lasota M.
        • et al.
        Survival of women with cancers of breast and genital organs in Europe 1999–2007: results of the EUROCARE-5 study.
        Eur J Cancer. 2015 Oct 1; 51: 2191-2205
        • Lachance J.A.
        • Everett E.N.
        • Greer B.
        • Mandel L.
        • Swisher E.
        • Tamimi H.
        • et al.
        The effect of age on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer.
        Gynecol Oncol. 2006 Jun 1; 101: 470-475
        • 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.
        Gynecol Obstet Fertil. 2012 Dec 1; 40: 759-764
        • Uccella S.
        • Bonzini M.
        • Palomba S.
        • Fanfani F.
        • Malzoni M.
        • Ceccaroni M.
        • et al.
        Laparoscopic vs. open treatment of endometrial cancer in the elderly and very elderly: an age-stratified multicenter study on 1606 women.
        Gynecol Oncol. 2016 May 1; 141: 211-217
        • Bishop E.A.
        • Java J.J.
        • Moore K.N.
        • Walker J.L.
        Pathologic and treatment outcomes among a geriatric population of endometrial cancer patients: an NRG oncology/gynecologic oncology group ancillary data analysis of LAP2.
        Int J Gynecol Cancer. 2017 May 1; 27
        • Truong P.T.
        • Kader H.A.
        • Lacy B.
        • Lesperance M.
        • MacNeil M.V.
        • Berthelet E.
        • et al.
        The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer.
        Am J Clin Oncol. 2005 Apr; 28: 157-164
        • Torgeson A.
        • Boothe D.
        • Poppe M.M.
        • Suneja G.
        • Gaffney D.K.
        Disparities in care for elderly women with endometrial cancer adversely effects survival.
        Gynecol Oncol. 2017 Nov 1; 147: 320-328
        • Ramesh H.S.J.
        • Jain S.
        • Audisio R.A.
        Implications of aging in surgical oncology.
        Cancer J. 2005 Dec; 11: 488-494
        • de Boer S.M.
        • Powell M.E.
        • Mileshkin L.
        • Katsaros D.
        • Bessette P.
        • Haie-Meder C.
        • et al.
        Adjuvant chemoradiotherapy versus radiotherapy alone for women with high-risk endometrial cancer (PORTEC-3): final results of an international, open-label, multicentre, randomised, phase 3 trial.
        Lancet Oncol. 2018 Mar; 19: 295-309
        • Rousselin A.
        • Bendifallah S.
        • Nyangoh Timoh K.
        • Ouldamer L.
        • Canlorbe G.
        • Raimond E.
        • et al.
        Patterns of care and the survival of elderly patients with high-risk endometrial cancer: a case-control study from the FRANCOGYN group.
        Eur J Surg Oncol. 2017 Nov; 43: 2135-2142
        • Ballester M.
        • Dubernard G.
        • Lécuru F.
        • Heitz D.
        • Mathevet P.
        • Marret H.
        • et al.
        Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO).
        Lancet Oncol. 2011 May; 12: 469-476
        • Pecorelli S.
        Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium.
        Int J Gynaecol Obstet. 2009 May; 105: 103-104
        • Concin N.
        • Matias-Guiu X.
        • Vergote I.
        • Cibula D.
        • Mirza M.R.
        • Marnitz S.
        • et al.
        ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma.
        Radiother Oncol. 2021 Jan; 154: 327-353
        • Querleu D.
        • Planchamp F.
        • Narducci F.
        • Morice P.
        • Joly F.
        • Genestie C.
        • et al.
        Clinical practice guidelines for the management of patients with endometrial cancer in France: recommendations of the Institut National du Cancer and the Société Française d'Oncologie Gynécologique.
        Int J Gynecol Cancer. 2011 Jul; 21: 945-950
        • Fleming N.D.
        • Lentz S.E.
        • Cass I.
        • Li A.J.
        • Karlan B.Y.
        • Walsh C.S.
        Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma?.
        Gynecol Oncol. 2011 Feb 1; 120: 189-192
        • Fiorentino A.
        • Chiumento C.
        • Fusco V.
        Do comorbidity influences acute toxicity and outcome in elderly patients with endometrial cancer treated by adjuvant radiotherapy plus brachytherapy?.
        Clin Transl Oncol. 2013 Aug; 15: 665-669
        • Clark L.H.
        • Jackson A.L.
        • Gehrig P.A.
        • Bae-Jump V.
        • Le L.V.
        • Ko E.M.
        Adjuvant treatment and clinical trials in elderly patients with endometrial cancer: a time for change?.
        Int J Gynecol Cancer. 2016 Feb 1; 26
        • Driver J.A.
        • Viswanathan A.N.
        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 Jun 1; 145: 526-530
        • Eggemann H.
        • Ignatov T.
        • Burger E.
        • Costa S.D.
        • Ignatov A.
        Management of elderly women with endometrial cancer.
        Gynecol Oncol. 2017 Sep 1; 146: 519-524
        • Lavoue V.
        • Zeng X.
        • Lau S.
        • Press J.Z.
        • Abitbol J.
        • Gotlieb R.
        • et al.
        Impact of robotics on the outcome of elderly patients with endometrial cancer.
        Gynecol Oncol. 2014 Jun 1; 133: 556-562
        • Zeng X.Z.
        • Lavoue V.
        • Lau S.
        • Press J.Z.
        • Abitbol J.
        • Gotlieb R.
        • et al.
        Outcome of robotic surgery for endometrial cancer as a function of patient age.
        Int J Gynecol Cancer. 2015 May; 25: 637-644
        • Lowe M.P.
        • Kumar S.
        • Johnson P.R.
        • Kamelle S.A.
        • Chamberlain D.H.
        • Tillmanns T.D.
        Robotic surgical management of endometrial cancer in octogenarians and nonagenarians: analysis of perioperative outcomes and review of the literature.
        J Robotic Surg. 2010 Aug 1; 4: 109-115
        • Bogani G.
        • Cromi A.
        • Uccella S.
        • Serati M.
        • Casarin J.
        • Pinelli C.
        • et al.
        Perioperative and long-term outcomes of laparoscopic, open abdominal, and vaginal surgery for endometrial cancer in patients aged 80 years or older.
        Int J Gynecol Cancer. 2014 Jun; 24: 894-900
        • Bourgin C.
        • Saidani M.
        • Poupon C.
        • Cauchois A.
        • Foucher F.
        • Leveque J.
        • et al.
        Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature.
        Eur J Surg Oncol. 2016 Feb 1; 42: 166-175
        • Gayar O.H.
        • Robbins J.R.
        • Parikh K.
        • Lu M.
        • Buekers T.
        • Munkarah A.
        • et al.
        Hysterectomy for uterine adenocarcinoma in the elderly: tumor characteristics, and long-term outcome.
        Gynecol Oncol. 2011 Oct 1; 123: 71-75
        • Lowery W.J.
        • Gehrig P.A.
        • Ko E.
        • Secord A.A.
        • Chino J.
        • Havrilesky L.J.
        Surgical staging for endometrial cancer in the elderly — is there a role for lymphadenectomy?.
        Gynecol Oncol. 2012 Jul 1; 126: 12-15
        • Racin A.
        • Raimond E.
        • Bendifallah S.
        • Nyangoh Timoh K.
        • Ouldamer L.
        • Canlorbe G.
        • et al.
        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
        • Vaknin Z.
        • Ben-Ami I.
        • Schneider D.
        • Pansky M.
        • Halperin R.
        A comparison of perioperative morbidity, perioperative mortality, and disease-specific survival in elderly women (≥70 Years) versus younger women (<70 Years) with endometrioid endometrial cancer.
        Int J Gynecol Cancer. 2009 Jul; 19: 879-883
        • Caillet P.
        • Canoui-Poitrine F.
        • Vouriot J.
        • Berle M.
        • Reinald N.
        • Krypciak S.
        • et al.
        Comprehensive geriatric assessment in the decision-making process in elderly patients with cancer: ELCAPA study.
        J Clin Orthod. 2011 Sep 20; 29: 3636-3642
        • Falandry C.
        • Savoye A.M.
        • Stefani L.
        • Tinquaut F.
        • Lorusso D.
        • Herrstedt J.
        • et al.
        EWOC-1: a randomized trial to evaluate the feasibility of three different first-line chemotherapy regimens for vulnerable elderly women with ovarian cancer (OC): a GCIG-ENGOT-GINECO study.
        J Clin Orthod. 2019 May 20; 37 (5508–5508)

      Index

      EC
      endometrial cancer
      SENTI-ENDO
      Sentinel Node Procedure and Endometrial Cancer
      CNGOF
      National College of French Obstetricians and Gynecologists
      BMI
      body mass index
      FIGO
      International Federation of Gynecology and Obstetrics
      ESMO
      European Society for Medical Oncology
      ESTRO
      European SocieTy for Radiotherapy & Oncology
      ESGO
      European Society of Gynecological Oncology
      LVSI
      lympho-vascular space invasion
      VBT
      vaginal brachytherapy
      EBRT
      external beam radiotherapy
      CT
      chemotherapy
      RT
      radiotherapy
      HIR
      high intermediate risk
      OS
      overall survival
      DFS
      disease-free survival
      SD
      standard deviation
      HR
      hazard ratio
      CI
      confidence interval