Prognostic Factors of Endometrial Cancer In The Elderly Patient Group and Their Effects On Survival

Alemdaroğlu, Songül; Durdağ, Gülşen Doğan; Baran, Şafak Yılmaz; Şimşek, Seda Yüksel; Yetkinel, Selçuk; Yağınç, Didem Alkaş; Güler, Ozan Cem; Çelik, Hüsnü

doi:10.14744/nci.2020.47154

Cited by 2 publications

(2 citation statements)

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“…This study confirmed that elderly women had a higher incidence of deep myometrial invasion, serous tumour histology and p53abn tumours, as seen by others. 2,4,5,7 However, in this study the correlation between older age and more aggressive tumour characteristics does not entirely explain the poorer oncological outcomes in elderly women. Age was found to be an independent risk factor, after correcting for stage, histotype and grade, LVSI, molecular class, adjuvant treatment and competing events.…”

Section: Discussioncontrasting

confidence: 57%

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Prognostic impact and causality of age on oncological outcomes in women with endometrial cancer: a multimethod analysis of the randomised PORTEC-1, -2 and -3 trials

Wakkerman,

Wu,

Putter

et al. 2023

Preprint

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BackgroundNumerous studies have shown that elderly women with endometrial cancer (EC) have a higher risk of recurrence and cancer-related death. It is, however, unclear whether aging is a causal prognostic factor, or whether other risk factors become increasingly common with age. We address to this with a unique multi-method study design using state of the art statistical and causal inference techniques on datasets of three large randomised trials.MethodsData of 1801 women participating in the randomised PORTEC-1, -2 and -3 trials were used for statistical analyses and causal inference. The cohort included 714 patients with intermediate-risk EC, 427 high-intermediate risk EC patients and 660 high-risk EC patients. Associations of age with clinicopathological and molecular features were analysed using non-parametric tests. Multivariable competing risk analyses were performed to determine the independent prognostic value of age. To analyse age as a causal prognostic variable a deep learning Causal Inference model called AutoCI was used.FindingsMedian follow-up was 12·3 years for PORTEC-1, 10·5 years for PORTEC-2 and 6·1 years for PORTEC-3. Both overall recurrence and EC-specific deaths significantly increased with age. Moreover, elderly women had a higher incidence of deep myometrial invasion, serous tumour histology and p53abn tumours. Age was an independent risk factor for both overall recurrence (HR 1·02 per year, 95%CI 1·01-1·04; p=0·0012) and EC-specific death (HR 1·03 per year, 95%CI 1·01-1·05; p=0·0012), and was identified as a significant causal variable.InterpretationThis study shows that advanced age is associated with more aggressive tumour features, and independently and causally related to worse oncological outcomes. Therefore, treatment for endometrial cancer in elderly women should not be de-escalated based on their age alone.FundingThe PORTEC-1, -2 and -3 trials and the associated translational studies are supported by the Dutch Cancer Society.

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Section: Discussioncontrasting

confidence: 57%

“…Nonetheless, many studies only evaluate the relation of age with overall survival. 2 Moreover, studies that do investigate recurrence or EC-specific survival often do not account for competing causes of death, which are more common in elderly, possibly leading to an overestimation of the impact of advanced age on prognosis.…”

Section: Introductionmentioning

confidence: 99%