Adélaïde Racin1, Emilie Raimond2, Sofiane Bendifallah3, Krystel Nyangoh Timoh1, Lobna Ouldamer4, Geoffroy Canlorbe5, Nina Hudry6, Charles Coutant6, Olivier Graesslin4, Cyril Touboul7, Pierre Collinet8, Alexandre Bricou9, Cyrille Huchon10, Martin Koskas11, Marcos Ballester12, Emile Daraï12, Jean Levêque1, Vincent Lavoue13. 1. CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France. 2. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France. 3. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France; INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France. 4. Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France. 5. INSERM UMR_S_707, "Epidemiology, Information Systems, Modeling", University Pierre and Marie Curie, Paris 6, France. 6. Center de lutte contre le cancer Georges François Leclerc, Dijon, France. 7. Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France. 8. Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire, Lille, France. 9. Department of Gynaecology and Obstetrics, Jean Verdier University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris 13, France. 10. Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal, Poissy, France. 11. Department of Gynaecology and Obstetrics, Bichat University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), France. 12. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France; INSERM UMR_S_938, University Pierre et Marie Curie, Paris 6, France. 13. CHU de Rennes, Service de Gynécologie, Hôpital Sud, 16 bd de Bulgarie, Université de Rennes 1, U1242, Chemistry, Oncogenesis, Stress and Signaling, CLCC Eugène Marquis, 35000, Rennes, France. Electronic address: vincent.lavoue@chu-rennes.fr.
Abstract
BACKGROUND: Pelvic and paraaortic lymphadenectomy are recommended for women with high-intermediate, high-risk and advanced endometrial cancer (EC). Lymphadenectomy is less frequently performed in elderly patients than in younger patients. We examined the survival of elderly women diagnosed with high-risk EC according to whether lymphadenectomy was performed or not. METHODS: We selected women over 70 years with high-intermediate risk, high-risk or advanced EC from a multicenter retrospective cohort of women diagnosed between 2001 and 2013. Multivariate logistic regression models and Cox proportional hazards survival methods for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were used for analyses. RESULTS: 71 women had lymphadenectomy and were compared with the 213 who did not. Recurrence was similar in both groups (42% vs 33%, respectively, p = 0.17) but more deaths were reported in the group without lymphadenectomy (38% vs 23%, respectively, p < 0.001). There was no difference in adjuvant treatment in the two groups (17% vs 27%, respectively, p = 0.27). Elderly patients without lymphadenectomy had lower 3-year DFS (56% vs 71%, p = 0.076), CSS (67% vs 85%, p < 0.001) and OS (50% vs 71% p < 0.001). The Cox proportional hazard models showed independently poorer prognosis in women without lymphadenectomy (3.027, 95% CI 1.58-5.81, p < 0.001), histology type 2 (3.46, 95% CI 1.51-7.97, p = 0.003) and lymphovascular space involvement (3.47, 95% CI 1.35-8.98, p = 0.01) on 3-year CSS. CONCLUSION: No lymphadenectomy in elderly patients with high-risk or advanced EC is independently associated with poorer prognosis. Elderly patients with EC should benefit from lymphadenectomy when indicated.
BACKGROUND: Pelvic and paraaortic lymphadenectomy are recommended for women with high-intermediate, high-risk and advanced endometrial cancer (EC). Lymphadenectomy is less frequently performed in elderly patients than in younger patients. We examined the survival of elderly women diagnosed with high-risk EC according to whether lymphadenectomy was performed or not. METHODS: We selected women over 70 years with high-intermediate risk, high-risk or advanced EC from a multicenter retrospective cohort of women diagnosed between 2001 and 2013. Multivariate logistic regression models and Cox proportional hazards survival methods for overall survival (OS), disease-free survival (DFS) and cancer-specific survival (CSS) were used for analyses. RESULTS: 71 women had lymphadenectomy and were compared with the 213 who did not. Recurrence was similar in both groups (42% vs 33%, respectively, p = 0.17) but more deaths were reported in the group without lymphadenectomy (38% vs 23%, respectively, p < 0.001). There was no difference in adjuvant treatment in the two groups (17% vs 27%, respectively, p = 0.27). Elderly patients without lymphadenectomy had lower 3-year DFS (56% vs 71%, p = 0.076), CSS (67% vs 85%, p < 0.001) and OS (50% vs 71% p < 0.001). The Cox proportional hazard models showed independently poorer prognosis in women without lymphadenectomy (3.027, 95% CI 1.58-5.81, p < 0.001), histology type 2 (3.46, 95% CI 1.51-7.97, p = 0.003) and lymphovascular space involvement (3.47, 95% CI 1.35-8.98, p = 0.01) on 3-year CSS. CONCLUSION: No lymphadenectomy in elderly patients with high-risk or advanced EC is independently associated with poorer prognosis. Elderly patients with EC should benefit from lymphadenectomy when indicated.