Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma.

Abstract

OBJECTIVE:

The purpose of this study was to explore in greater depth the outcomes of the Italian randomized trial investigating the role of pelvic lymphadenectomy in clinical early stage endometrial cancer. In the attempt to identify the patients with poorer prognosis, the impact of age and body mass index were also thoroughly investigated by cancer-specific survival (CSS) analyses.

STUDY DESIGN:

Survival outcomes of trial patients were analyzed in relation to age (≤65 years and >65 years) in the 2 arms (lymphadenectomy and no lymphadenectomy) and in the whole population of the trial.

RESULTS:

Univariate and multivariable analyses of CSS and overall survival (OS) of patients showed that age >65 years is a strong independent poor prognostic factor (5-y OS 92.1% and 78.4% in ≤65 years and >65 years patients, respectively, P < .0001; 5-y CSS 93.8% and 83.5% in ≤65 years and >65 years patients, respectively, P = .003). Among women ≤65 years, node negative patients had 94.4% 5-y OS and 96.3% 5-y CSS vs 74.3% 5-y OS and 74.3% 5-y CSS for node positive patients (P = .009 and P = .002, respectively), while among women >65 y, node negative patients had 75.7% 5-y OS and 83.6% 5-y CSS vs 74.1% 5-y OS and 83.3% 5-y CSS for node positive patients (P = .55 and P = .58, respectively). Univariate and multivariable survival analyses in the whole trial population showed that older age, and higher tumor grade and stage were significantly associated to a worse prognosis.

CONCLUSION:

Older women faced an intrinsic poorer survival whether or not they underwent lymphadenectomy, and, unexpectedly, irrespective of the presence of nodal metastasis. Only in older patients was obesity (body mass index >30) significantly associated with scarce prognosis.

• Authors: Pierluigi Benedetti Panici, Stefano Basile, Maria Giovanna Salerno, Violante Di Donato, Claudia Marchetti, Giorgia Perniola, Antonio Palagiano, Alessandra Perutelli, Francesco Maneschi, Andrea Alberto Lissoni, Mauro Signorelli, Giovanni Scambia, Saverio Tateo, Giorgia Mangili, Dionyssios Katsaros, Elio Campagnutta, Nicoletta Donadello, Stefano Greggi, Mauro Melpignano, Francesco Raspagliesi, Gennaro Cormio, Roberto Grassi, Massimo Franchi, Diana Giannarelli, Roldano Fossati, Valter Torri, Clara Crocè, Costantino Mangioni
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 210 Issue 4 Pg. 363.e1-363.e10 (Apr 2014) ISSN: 1097-6868 [Electronic] United States
• PMID: 24361787 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2014 Mosby, Inc. All rights reserved.

Topics

• Age Factors
• Aged
• Body Mass Index
• Carcinoma (mortality, pathology, therapy)
• Combined Modality Therapy
• Endometrial Neoplasms (mortality, pathology, therapy)
• Female
• Humans
• Kaplan-Meier Estimate
• Lymph Node Excision
• Lymphatic Metastasis
• Multivariate Analysis
• Neoplasm Grading
• Neoplasm Metastasis
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Obesity, Abdominal (epidemiology)
• Prognosis