The prognostic significance of age in surgically staged patients with Type II endometrial carcinoma

Objective: Many studies have examined the impact of older age on tumor recurrence and survival after hysterectomy for patients with endometrioid carcinoma. However, there is paucity of data examining the prognostic significance of age in patients with Type II endometrial carcinoma. The study was conducted to determine the prognostic impact of age in this patient population.

Materials and methods: In this Institutional Review Board (IRB)-approved study, our prospectively-maintained database of 1305 patients with endometrial cancer was reviewed. Seventy-two consecutive patients with serous and clear carcinoma 2009 FIGO stages I-II were identified with at least one year follow-up after surgical staging. Patients with mixed histology and those who received preoperative therapy were excluded. All the patients underwent surgical staging from 1989 to 2009. Their medical records were reviewed. The study cohort was divided into two groups based on their age at hysterectomy (≤ 65 vs. >65). Patient's demographics, pathologic features and treatment-related factors were compared. The impact of age on recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Following univariate analysis, multivariate modeling was done using step-wise Cox proportional hazards analysis to assess the impact of age on clinical outcomes after adjusting for various clinical variables.

Results: Median follow-up for the study cohort was 45 months (range 13-246). Fifty percent of patients received adjuvant platinum-based chemotherapy and/or adjuvant radiation treatment (RT). Thirty-five patients were older than 65 years (49%) and 37 were ≤ 65 (51%). There were no significant differences between the two groups in regard to race (African American vs Caucasian), FIGO stage, number of lymph nodes dissected, lymphovascular space involvement (LVSI), or adjuvant therapy received. There were more clear cell histology in the younger age group (p=0.035). Patients >65 years old developed more recurrences with a 5-year RFS of 59% compared to 84% for younger patients (p=0.036). The five-year DSS was not statistically different between the two groups (68% vs. 79%, respectively with p=0.313). 5-year OS was significantly shorter in the elderly patients (58% vs. 78% with p=0.014). On multivariate analysis, the presence of LVSI, not receiving RT and age >65 were independent predictors of worse RFS (p=<0.001, 0.005, and 0.040 respectively).

Conclusion: In this study for surgically staged FIGO I-II patients with Type II endometrial carcinoma, age more than 65 years is a significant adverse prognostic factor for tumor recurrence.