Hysterectomy for uterine adenocarcinoma in the elderly: Tumor characteristics, and long-term outcome

Objectives

To evaluate the tumor recurrences and survival in elderly patients ≥ 75 years of age with uterine endometrioid carcinoma treated with surgical staging with/without adjuvant radiation therapy (RT).

Methods

We identified 675 surgically staged patients with FIGO stage I–II uterine endometrioid carcinoma who were treated between 1985 and 2009. Their medical records were retrospectively reviewed in this IRB-approved study. Patients were classified as ≥ 75 years vs. < 75 years and compared regarding tumor recurrence and survival. Following a univariate analysis, multivariable modeling was done using Cox regression analysis.

Results

121 patients (18%) were ≥ 75 years old at the time of hysterectomy. For this group of elderly patients, median age was 79. All patients were surgically staged and some received adjuvant RT. Older patients were found to have higher FIGO stages (p < 0.001), higher grade tumors (p < 0.001), more frequent deep myometrial involvement (p < 0.001), and more frequent lower uterine segment involvement (p < 0.001). There was no significant difference found between older and younger patients with respect to lymphovascular space involvement (LVSI) (p = 0.415), number of lymph nodes dissected (p = 0.440), or adjuvant RT received (p = 0.089). Older patients had more tumor recurrence (15% vs 7%) (p = 0.005) and lower five year relapse-free survival of 80% compared to 90% in younger patients (p = 0.0016). Multivariate analysis confirmed the significance of LVSI, grade 3 tumors, and deep myometrial invasion as prognostic factors for recurrence. After adjusting for other poor prognostic factors, age was not found to be an independent prognostic factor for recurrence.

Conclusion

Despite similar surgical staging and adjuvant radiation treatment, patients ≥ 75 years old diagnosed with FIGO stage I–II uterine endometrioid carcinoma were found to have more adverse pathologic features and worse relapse-free, disease-specific and overall survival than younger patients. Age ≥ 75 years alone may not be an independent significant prognostic factor affecting tumor recurrence.