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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Gynecologic Oncology

Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group

Authors: Clothilde Poupon, MD, Sofiane Bendifallah, MD, PhD, Lobna Ouldamer, MD, PhD, Geoffroy Canlorbe, MD, PhD, Emilie Raimond, MD, Nina Hudry, MD, Charles Coutant, MD, PhD, Olivier Graesslin, MD, PhD, Cyril Touboul, MD, PhD, Pierre Collinet, MD, PhD, Alexandre Bricou, MD, Cyrille Huchon, MD, PhD, Emile Daraï, MD, PhD, Marcos Ballester, MD, PhD, Jean Levêque, MD, PhD, Vincent Lavoue, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

Little data exist about the clinical management and survival of elderly patients with endometrial cancer. This study aimed to evaluate the management of elderly and very elderly patients with endometrial cancer as well as the overall survival (OS) rate, disease-free survival (DFS) rate, and cancer-specific survival (CSS) rate in a multicenter cohort.

Methods

Data from 1228 patients with endometrial cancer who received primary treatment between January 2001 and December 2012 were collected from a multicenter database. Clinical management, DFS, CSS, and OS were analyzed.

Results

Based on the international endometrial cancer risk classification, 36% (212/582) of women age 65 years or younger, 42% (220/526) of women ages 65–80 years, and 48% (58/120) of women older than 80 years showed high-risk endometrial cancer (p < 0.001). Pelvic lymphadenectomy was performed for 85% (230/271) of the women age 65 years or younger and 46% (33/71) of the women older than 80 years (p < 0.001). Radiotherapy was performed for 27% (33/120) of the very elderly and 40% (233/582) of the young patients (p = 0.009). The 3-year CSS rates were 95% (95% confidence interval [CI], 93–97%) for the women age 65 years or younger, 90% (95% CI, 87–94%) for the women ages 65–80 years, and 82% (95% CI, 73–93%) for the women older than 80 years (p < 0.001).

Conclusions

The elderly and very elderly patients with endometrial cancer showed poorer prognosis than young patients. The significant lower CSS rate for the elderly patients could have be due to both the higher rate of high-risk endometrial cancer and undertreatment. Specific guidelines for the management of elderly and very elderly patients with endometrial cancer are needed to improve their prognosis.
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Literature
1.
Reis L, Eisner M, Kosary C, et al. SEER Cancer Statistics Review, 1975–2000. National Cancer Institute, Bethesda; 2003.
2.
3.
Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1054 patients. J Clin Oncol. 2001;19:666–75.CrossRefPubMed
4.
Lewis JH, Kilgore ML, Goldman DP, et al. Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol. 2003;21:1383–9.CrossRefPubMed
5.
Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341:2061–7.CrossRefPubMed
6.
Yee KW, Pater JL, Pho L, Zee B, Siu LL. Enrollment of older patients in cancer treatment trials in Canada: why is age a barrier? J Clin Oncol. 2003;21:1618–23.CrossRefPubMed
7.
Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA. Representation of older patients in cancer treatment trials. Cancer. 1994;74:2208–14.CrossRefPubMed
8.
Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on US cancer burden. Cancer. 2002;94:2766–92.CrossRefPubMed
9.
Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31:128–36.CrossRefPubMed
10.
Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011;61:212–36.CrossRefPubMed
11.
12.
Mikuta JJ. International federation of gynecology and obstetrics staging of endometrial cancer 1988. Cancer. 1993;71:1460–3.CrossRefPubMed
13.
Colombo N, Preti E, Landoni F, et al. Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2013;24(Suppl 6):vi33–8.
14.
Bendifallah S, Canlorbe G, Collinet P, et al. Just how accurate are the major risk stratification systems for early-stage endometrial cancer? Br J Cancer. 2015;112:793–801.CrossRefPubMedPubMedCentral
15.
Group SGOCPECW, Burke WM, Orr J, et al. Endometrial cancer: a review and current management strategies: part II. Gynecol Oncol. 2014;134:393–402.
16.
Group SGOCPECW, Burke WM, Orr J, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014;134:385–92.
17.
Zeng XZ, Lavoue V, Lau S, et al. Outcome of robotic surgery for endometrial cancer as a function of patient age. Int J Gynecol Cancer. 2015;25:637–44.CrossRefPubMed
18.
19.
Uccella S, Bonzini M, Palomba S, 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;141:211–7.CrossRefPubMed
20.
Scribner DR Jr, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS. Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible? Gynecol Oncol. 2001;83:563–8.CrossRefPubMed
21.
Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311:2110–20.CrossRefPubMed
22.
Ballester M, Dubernard G, Lecuru F, 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;12:469–76.CrossRefPubMed
23.
Singletary SE, Allred C, Ashley P, et al. Revision of the American Joint Committee on Cancer staging system for breast cancer. J Clin Oncol. 2002;20:3628–36.CrossRefPubMed
24.
Briet JM, Hollema H, Reesink N, et al. Lymphvascular space involvement: an independent prognostic factor in endometrial cancer. Gynecol Oncol. 2005;96:799–804.CrossRefPubMed
25.
Querleu D, Planchamp F, Narducci F, et al. Clinical practice guidelines for the management of patients with endometrial cancer in France: recommendations of the Institut National du Cancer and the Societe Francaise d’Oncologie Gynecologique. Int J Gynecol Cancer. 2011;21:945–50.CrossRefPubMed
26.
Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet. 2009;105:103–4.CrossRefPubMed
27.
Bourgin C, Saidani M, Poupon C, et al. Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature. Eur J Surg Oncol. 2016;42:166–75.CrossRefPubMed
28.
De Marzi P, Ottolina J, Mangili G, et al. Surgical treatment of elderly patients with endometrial cancer (≥65 years). J Geriatr Oncol. 2013;4:368–73.CrossRefPubMed
29.
Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.CrossRefPubMed
30.
Morice P, Leary A, Creutzberg C, Abu-Rustum N, Darai E. Endometrial cancer. Lancet. 2016;387:1094–108.CrossRefPubMed
31.
Koskas M, Rouzier R, Amant F. Staging for endometrial cancer: the controversy around lymphadenectomy—can this be resolved? Best Pract Res Clin Obstet Gynaecol. 2015;29:845–57.CrossRefPubMed
32.
Raimond E, Ballester M, Hudry D, et al. Impact of sentinel lymph node biopsy on the therapeutic management of early-stage endometrial cancer: results of a retrospective multicenter study. Gynecol Oncol. 2014;133:506–11.CrossRefPubMed
33.
Kang S, Yoo HJ, Hwang JH, Lim MC, Seo SS, Park SY. Sentinel lymph node biopsy in endometrial cancer: meta-analysis of 26 studies. Gynecol Oncol. 2011;123:522–7.CrossRefPubMed
34.
Clark LH, Jackson AL, Gehrig PA, Bae-Jump V, Van Le L, Ko EM. Adjuvant treatment and clinical trials in elderly patients with endometrial cancer: a time for change? Int J Gynecol Cancer. 2016;26:282–9.CrossRefPubMed
35.
Truong PT, Kader HA, Lacy B, et al. The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer. Am J Clin Oncol. 2005;28:157–64.CrossRefPubMed
36.
Rauh-Hain JA, Pepin KJ, Meyer LA, et al. Management for elderly women with advanced-stage, high-grade endometrial cancer. Obstet Gynecol. 2015;126:1198–206.CrossRefPubMed
37.
Magne N, Mancy NC, Chajon E, et al. Patterns of care and outcome in elderly cervical cancer patients: a special focus on brachytherapy. Radiother Oncol. 2009;91:197–201.CrossRefPubMed
38.
Ikushima H, Takegawa Y, Osaki K, et al. Radiation therapy for cervical cancer in the elderly. Gynecol Oncol. 2007;107:339–43.CrossRefPubMed
39.
Hamilton CA, Cheung MK, Osann K, et al. Uterine papillary serous and clear cell carcinomas predict for poorer survival compared to grade 3 endometrioid corpus cancers. Br J Cancer. 2006;94:642–6.PubMedPubMedCentral
40.
Greggi S, Mangili G, Scaffa C, et al. Uterine papillary serous, clear cell, and poorly differentiated endometrioid carcinomas: a comparative study. Int J Gynecol Cancer. 2011;21:661–7.CrossRefPubMed
41.
Bosse T, Peters EE, Creutzberg CL, et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer: a pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer. 2015;51:1742–50.CrossRefPubMed
42.
Robinson TN, Eiseman B, Wallace JI, et al. Redefining geriatric preoperative assessment using frailty, disability, and comorbidity. Ann Surg. 2009;250:449–55.PubMed
43.
Hurria A, Togawa K, Mohile SG, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol. 2011;29:3457–65.CrossRefPubMedPubMedCentral
44.
Hurria A, Mohile S, Gajra A, et al. Validation of a prediction tool for chemotherapy toxicity in older adults with cancer. J Clin Oncol. 2016;34:2366–71.CrossRefPubMedPubMedCentral
45.
Achouri A, Huchon C, Bats AS, Bensaid C, Nos C, Lecuru F. Complications of lymphadenectomy for gynecologic cancer. Eur J Surg Oncol. 2013;39:81–6.CrossRefPubMed
46.
Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and major morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.CrossRefPubMed
47.
Extermann M, Boler I, Reich RR, et al. Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score. Cancer. 2012;118:3377–86.CrossRefPubMed
48.
Dumas L, Ring A, Butler J, Kalsi T, Harari D, Banerjee S. Improving outcomes for older women with gynaecological malignancies. Cancer Treat Rev. 2016;50:99–108.CrossRefPubMed
49.
Huisman MG, Kok M, de Bock GH, van Leeuwen BL. Delivering tailored surgery to older cancer patients: preoperative geriatric assessment domains and screening tools: a systematic review of systematic reviews. EJSO. 2016
Metadata
Title
Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group
Authors
Clothilde Poupon, MD
Sofiane Bendifallah, MD, PhD
Lobna Ouldamer, MD, PhD
Geoffroy Canlorbe, MD, PhD
Emilie Raimond, MD
Nina Hudry, MD
Charles Coutant, MD, PhD
Olivier Graesslin, MD, PhD
Cyril Touboul, MD, PhD
Pierre Collinet, MD, PhD
Alexandre Bricou, MD
Cyrille Huchon, MD, PhD
Emile Daraï, MD, PhD
Marcos Ballester, MD, PhD
Jean Levêque, MD, PhD
Vincent Lavoue, MD, PhD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5735-9

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