Although age is considered a traditional risk factor for relapse in stage I endometrial cancer, whether it impacts endometrial cancer-related death is unclear. We aimed to assess disease risk factors, overall survival (OS), disease-free survival (DFS), and cancer-specific survival, in patients > =70 (OP) vs. <70 (YP) years of age with or without adjuvant therapy.
We reviewed medical records of all patients who underwent surgery for stage I endometrial cancer between 2000 and 2013 in British Columbia, Canada. Descriptive, logistic regression, multivariate Cox regression and competing risks analyses were used to evaluate patient outcomes.
365 OP and 1063 YP were included (n = 1428). No significant differences were found between OP and YP with regards to disease risk factors such as stage IB disease and lymphovascular invasion (LVI). However, OP had higher odds of non-endometrioid histology (OR 1.88, p < 0.001). 22 (6%) OP and 78 (7.3%) YP received adjuvant chemotherapy (CT); 120 (32.9%) OP and 290 (27.3%) YP received adjuvant radiotherapy (RT). When adjusted for histology, LVI and grade, YP were more likely to receive CT (OR 2.10, p = 0.009); no significant difference in odds of receiving RT was found between YP and OP (OR 0.86, p = 0.33). OP experienced higher odds of relapse (OR 1.95, p = 0.001) and worse OS (HR 4.12, p < 0.001) and DFS (HR 2.18, p < 0.001) than YP after adjusting for risk factors. 10-year OS (endometrioid: 61.9 vs 89.2%; non-endometrioid: 46.1 vs 85.8%, p < 0.001) and DFS (endometrioid: 86.7 vs 91.9%; non-endometrioid: 69.6 vs 84.5%, p < 0.001) were worse for OP. Controlling for risk factors, OP experienced a higher incidence of endometrial cancer-related death than YP (HR = 2.09, p < 0.001).
In patients with stage I endometrial cancer, patients > =70 years had higher odds of having non-endometrioid histology as well as relapse and death due to endometrial cancer, yet were less likely to receive adjuvant CT. Appropriate adjuvant therapy should be considered regardless of age, as recurrent disease is still a significant cause of mortality in older patients with stage I endometrial cancer.
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All authors have declared no conflicts of interest.