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

Poupon, Clothilde; Bendifallah, Sofiane; Ouldamer, Lobna; Canlorbe, Geoffroy; Raimond, Émilie; Hudry, Delphine; Coutant, Charles; Graesslin, Olivier; Touboul, Cyril; Collinet, Pierre; Bricou, Alexandre; Huchon, Cyrille; Daraı̈, Émile; Ballester, Marcos; Lévèque, Jean; Lavoué, Vincent

doi:10.1245/s10434-016-5735-9

Cited by 27 publications

(25 citation statements)

References 49 publications

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“…Age is known to be associated with poor prognosis in EC. The likelihood of poor prognostic factors and the recurrence increases with increasing of the age and survival in this group of patients is significantly reduced (28)(29)(30). The probability of recurrence increased 2.2-fold with age in our study.…”

Section: Discussionsupporting

confidence: 44%

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

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Türkmen

Kılıç

et al. 2018

Gynecol Obstet Reprod Med

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Objective: To define recurrence pattern of endometrioid type endometrium cancer performed adjuvant radiotherapy.Study Design: 351 patients who underwent at least total abdominal hysterectomy with bilateral salpingo-oophorectomy and followed by adjuvant radiotherapy (vaginal brachytherapy or pelvic radiotherapy or both) for endometrioid type endometrium carcinoma were included. The patients who received systemic adjuvant treatment after surgery were excluded from the study except for 18 patients who received concomitant chemo-radiotherapy. Recurrence was categorized as pelvic recurrence included areas distal to the pelvic inlet, as abdominal recurrence included areas between pelvic inlet and diaphragm and findings such as ascites and peritonitis carcinomatosa, and the rest of recurrences including lung, cutaneous, liver parenchyma and bone as extra-abdominal recurrence.Results: The median age was 57 years (range; 29-82). 236 patients had stage I, 25 had stage II, 63 had stage III and 14 had stage IV disease (by FIGO 2009). Lymph node metastasis was determined in 21.8% of patients who underwent lymphadenectomy (n: 289). The median follow-up time was 46 months (range; 1-190). Throughout follow-up, recurrence was developed in 55 (15.7%) patients. Only pelvic recurrence was determined in 11 (3.1%) patients. There was recurrence beyond the pelvis in 44 (80%) of the recurrent patients. Thirty-five (%63.6) of recurrent patients had extra-abdominal recurrence. Twenty-three (41.8%) of recurrent patients had stage IB disease. The recurrence developed in 10% of patients with stage I&II, whereas it was occurred in 31% of patients with stage III&IV (p<0.0001).Conclusion: Radiotherapy provides local control of the disease, but recurrence is likely to be extra-pelvic and extra-abdominal in this patient group.

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Section: Discussionsupporting

confidence: 44%

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Durmuş

Türkmen

Kılıç

et al. 2018

Gynecol Obstet Reprod Med

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“…Furthermore age at diagnosis is an important factor in endometrial cancer survival [32]. Elderly patients often have more aggressive histology and are less likely to receive surgical treatment or adjuvant therapy leading to under treatment [33]. Furthermore an article by Poupon et al [33] showed 3-year OS rates to be lower than cancer specific survival rate, indicating that death in elderly is often a combination of death due to cancer as well as to causes other than cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Elderly patients often have more aggressive histology and are less likely to receive surgical treatment or adjuvant therapy leading to under treatment [33]. Furthermore an article by Poupon et al [33] showed 3-year OS rates to be lower than cancer specific survival rate, indicating that death in elderly is often a combination of death due to cancer as well as to causes other than cancer. All studies included in this review have adjusted for age at diagnosis with the exemption of Cheung et al [18].…”

Section: Discussionmentioning

confidence: 99%

Systematic review on socioeconomic deprivation and survival in endometrial cancer

Donkers

Bekkers

Massuger

et al. 2019

Cancer Causes Control

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“…In the United States, the number of new cases of EC per year was 61 380 with 10 920 deaths in 2017 (7th leading cause of cancer related-death in women) (9). According to studies, older patients with EC have a poorer prognosis which is due not only to more aggressive disease but also undertreatment (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

“…Although the SEPAL study demonstrated a significant benefit of pelvic plus paraaortic lymphadenectomy on survival (19,20), lymphadenectomy was less performed in elderly patients with EC, even if lymphadenectomy was recommended by ESMO/ESGO/ESTRO guidelines (7,10,12), for fear of complications. Similarly, the older patient is less likely to receive pelvic external radiotherapy or chemotherapy which are recommended for patients with HR EC (14) (2,21).…”

Section: Introductionmentioning

confidence: 99%

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!

Racin

Raimond²,

Bendifallah

et al. 2019

European Journal of Surgical Oncology

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BACKGROUND: Pelvic and paraaortic lymphadenectomy are recommended for women with highintermediate, 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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Management and Survival of Elderly and Very Elderly Patients with Endometrial Cancer: An Age-Stratified Study of 1228 Women from the FRANCOGYN Group

Cited by 27 publications

References 49 publications

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Recurrence Pattern after Adjuvant Radiotherapy for Endometrioid Type Endometrial Cancer

Systematic review on socioeconomic deprivation and survival in endometrial cancer

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!

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