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. 2023 Jul 10:49:101240.
doi: 10.1016/j.gore.2023.101240. eCollection 2023 Oct.

Surgical and oncologic outcomes in surgically treated women 80 years and older with endometrioid endometrial cancer as a function of their comorbidities

Abdelrahman AlAshqar  1 , Maddie Ghazarian  1 , Emily M Webster  1 , Animesh Upadhyay  1 , Masoud Azodi  1 , Peter E Schwartz  1 , Elena Ratner  1 , Gary Altwerger  1
Affiliations

Surgical and oncologic outcomes in surgically treated women 80 years and older with endometrioid endometrial cancer as a function of their comorbidities

Abdelrahman AlAshqar et al. Gynecol Oncol Rep. .

Abstract

Objective: To describe the surgical and oncologic outcomes in surgically treated oldest old women (≥80 years) with endometrioid endometrial cancer as a function of their comorbidities.

Methods: In this retrospective cohort study, patients aged 80-99 years who underwent surgical management of stage I endometrioid endometrial cancer between 2006 and 2018 were included. Low- and high-intermediate risk disease was defined using the Gynecologic Oncology Group-99 criteria. The validated, Combined Age-Charlson Comorbidity Index (CA-CCI) was used to quantify comorbidity burden. Logistic regression was used to identify the independent predictors of various surgical and oncologic outcomes. Kaplan-Meier survival analysis was performed to compare survival distributions based on mortality cause and comorbidity status.

Results: We identified 64 women who met the eligibility criteria. Median age was 84 years (IQR 80, 94 years). Among oldest old women undergoing a hysterectomy with or without lymph node dissection, women with a CA-CCI score of ≥7 had an 8 times higher risk of postoperative infections compared with oldest old women with a <7 score (95% CI 1.53-48.91, P = 0.015). Women with a CA-CCI score of ≥8 were 45% less likely to survive at 3 years (aRR 0.55, 95% CI 0.004-0.87; P = 0.039) than those with a lower CA-CCI score (three-year overall survival 73% vs 96%).

Conclusion: Surgical and oncologic outcomes in oldest old women with early stage endometrioid endometrial cancer are largely determined by comorbidity status. Less comorbid women (CA-CCI score < 8) had a significantly higher five-year survival at 87% than their more comorbid counterparts. Use of age-comorbidity risk scoring such as CA-CCI, preoperative optimization, and careful selection for and counseling of patients about surgical treatment are paramount in providing optimal recovery and survival advantages in the oldest old.

Keywords: Cancer survival; Comorbidity Index; Mortality; Older women; Postoperative outcomes; Uterine cancer.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Rates of surgical outcomes by hysterectomy approach and comorbidity status (CA-CCI score).
Fig. 2
Fig. 2
A. Proportion of mortality by cause; B. Probability of overall survival by mortality cause over the follow up period; C. Probability of overall survival by comorbidity status (CA-CCI score) over the follow up period.
Fig. 3
Fig. 3
A. Probability of crude overall survival over the follow up period. B. Probability of crude progression-free survival over the follow up period.
See this image and copyright information in PMC

References

    1. Amant F., Moerman P., Neven P., Timmerman D., Van Limbergen E., Vergote I. Endometrial cancer. Lancet. 2005;366(9484):491–505. - PubMed
    1. Bentrem D.J., Cohen M.E., Hynes D.M., Ko C.Y., Bilimoria K.Y. Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch. Surg. 2009;144(11):1013–1020. - PubMed
    1. Bishop E.A., Java J.J., Moore K.N., Spirtos N.M., Pearl M.L., Zivanovic O., et al. Surgical outcomes among elderly women with endometrial cancer treated by laparoscopic hysterectomy: a NRG/Gynecologic Oncology Group study. Am. J. Obstet. Gynecol. 2018;218(1) 109 e1- e11. - PMC - PubMed
    1. Casarin J., Multinu F., Tortorella L., Cappuccio S., Weaver A.L., Ghezzi F., Cliby W., Kumar A., Langstraat C., Glaser G., Mariani A. Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes. Int. J. Gynecol. Cancer. 2020;30(1):41–47. - PubMed
    1. Charlson M.E., Pompei P., Ales K.L., MacKenzie C.R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic. Dis. 1987;40(5):373–383. doi: 10.1016/0021-9681(87)90171-8. PMID: 3558716. - DOI - PubMed

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