Research Article| Volume 242, P36-42, November 2019

Download started.


Management of endometrial cancer in patients aged 80 years and older

Identifying patients who may benefit from a curative treatment
Published:September 17, 2019DOI:



      The goal of this study was to evaluate the demographic characteristics, pathology, treatment, prognostic factors and survival rates in elderly patients with endometrial cancer, and to compare their results with those of younger ones, in order to define the specific characteristics of this malignancy in this population.
      Study design: Retrospective analysis of all endometrial cancer patients managed at the University Hospital of the Canary Islands (Spain) between 1990 and 2016. Survival curves were calculated by using the Kaplan-Meier method and compared with the log-rank test. Logistic regression analysis was used to assess the independent effect of different variables on cancer-specific survival. Statistical significance was considered for p < 0.05.


      The study included 1799 endometrial cancer patients; 170 of them (9.4%) were 80 years old or older. Elderly patients received less surgery (68.2% vs. 92.4%), lymphadenectomy (10.3% vs. 26.2%) and adjuvant treatment (37.1% vs. 51.2%) than younger ones, and presented higher probability of receiving palliative treatment (27.6% vs. 4%). Endometrioid tumors were more frequently diagnosed in younger patients (78.8% vs. 62.9%), while type 2-endometrial cancer was more frequently diagnosed in elderly ones (37.1% vs. 21.2%).
      Cancer-specific survival in older patients was significantly poorer than in younger ones, with a mean of 61.4 months (95%CI 51.7–71.1) versus 226 months (95%CI 218.9–233.1), respectively. In a multivariate analysis: age, FIGO stage, histology, tumor differentiation and adjuvant treatment were independently associated with survival.


      Although endometrial cancer is more aggressive in older patients, they are less likely to receive optimal treatment, which negatively affects their survival. Specific guidelines for the management of this population, including a comprehensive geriatric assessment, should be developed to improve their prognosis.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Data source: Globocan 2018
        Graph production: global Cancer observatory.
        International Agency for Research on Cancer, 2018
        • Ferlay J.
        • Soerjomataram I.
        • Dikshit R.
        • Eser S.
        • Mathers C.
        • Rebelo M.
        • et al.
        Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012.
        Int J Cancer. 2015; 136: E359-386
        • Torgeson A.
        • Boothe D.
        • Poppe M.M.
        • Suneja G.
        • Gaffney D.K.
        Disparities in care for elderly women with endometrial cancer adversely effects survival.
        Gynecology Oncology. 2017; 147: 320-328
        • Abellán A.
        • Ayala A.
        • Pérez J.
        • Pujol R.
        • Un perfil de las personas mayores en España
        Indicadores estadísticos básicos. Madrid, Informes Envejecimiento en red nº 17.
        (34p. Cited: 07/02/2018)2018
        • Population ageing in Europe. Facts, implications and policies
        Directorate‐general for research and innovation socioeconomic sciences and humanities.
        European Union. 2014; (Cited: 31/01/2019)
        • Eggemann H.
        • Ignatov T.
        • Burger E.
        • Dan Costa S.
        • Ignatov A.
        Management of elderly women with endometrial cancer.
        Gynecol Oncol. 2017; 146: 519-524
        • Poupon C.
        • Bendifallah S.
        • Ouldamer L.
        • Canlorbe G.
        • Raimond E.
        • Hudry N.
        • et al.
        Management and survival of elderly and very elderly patients with endometrial Cancer: an age-stratified study of 1228 women from the FRANCOGYN group.
        Ann Surg Oncol. 2017; 24: 1667-1676
        • Bourgin C.
        • Saidani M.
        • Poupon C.
        • Cauchois A.
        • Foucher F.
        • Leveque J.
        • et al.
        Endometrial cancer in elderly women: which disease, which surgical management? A systematic review of the literature.
        Eur J Surg Oncol. 2016; 42: 166-175
        • Lowe M.P.
        • Kumar S.
        • Johnson P.R.
        • Kamelle S.A.
        • Chamberlain D.H.
        • Tillmanns T.D.
        Robotic surgical management of endometrial cancer in octogenarians and nonagenarians: analysis of perioperative outcomes and review of the literature.
        J Robot Surg. 2010; 4: 109-115
        • Bogani G.
        • Cromi A.
        • Uccella S.
        • Serati M.
        • Casarin J.
        • Pinelli C.
        • et al.
        Perioperative and long-term outcomes of laparoscopic, open abdominal, and vaginal surgery for endometrial cancer in patients aged 80 years or older.
        Int J Gynecol Cancer. 2014; 24: 894-900
        • Zeng X.Z.
        • Lavoue V.
        • Lau S.
        • Press J.Z.
        • Abitbol J.
        • Gotlieb R.
        • et al.
        Outcome of robotic surgery for endometrial cancer as a function of patient age.
        Int J Gynecol Cancer. 2015; 25: 637-644
        • Clark L.H.
        • Jackson A.L.
        • Gehrig P.A.
        • Bae-Jump V.
        • Van Le L.
        • Ko E.M.
        Adjuvant treatment and clinical trials in elderly patients with endometrial Cancer: a time for change?.
        Int J Gynecol Cancer. 2016; 26: 282-289
        • Palaia I.
        • Loprete E.
        • Musella A.
        • Marchetti C.
        • Di Donato V.
        • Bellati F.
        • et al.
        Chemotherapy in elderly patients with gynecological cancer.
        Oncology. 2013; 85: 168-172
        • Fiorentino A.
        • Chiumento C.
        • Fusco V.
        Do comorbidity influences acute toxicity and outcome in elderly patients with endometrial cancer treated by adjuvant radiotherapy plus brachytherapy?.
        Clin Transl Oncol. 2013; 15: 665-669
        • Zachariah B.
        • Balducci L.
        • Venkattaramanabalaji G.V.
        • Casey L.
        • Greenberg H.M.
        • DelRegato J.A.
        Radiotherapy for cancer patients aged 80 and older: a study of effectiveness and side effects.
        Int J Radiat Oncol Biol Phys. 1997; 39: 1125-1129
        • Lu Q.
        • Liu H.
        • Liu C.
        • Wang S.
        • Li S.
        • Guo S.
        • et al.
        Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience.
        J Cancer Res Clin Oncol. 2013; 139: 1853-1859
        • Galaal K.
        • Donkers H.
        • Bryant A.
        • Lope A.D.
        Laparoscopy versus laparotomy for the management of early stage endometrial cancer.
        Cochrane Database Syst Rev. 2018; 31
        • Ciavattini A.
        • Di Giuseppe J.
        • Cecchi S.
        • et al.
        Gynecologic laparoscopy in patients aged 65 or more: feasibility and safety in the presence of increased comorbidity.
        Eur J Obstet Gynecol Reprod Biol. 2014; 175: 49-53
        • 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: 109.e1-109.e11
        • Gallotta V.
        • Conte C.
        • D’Indinosante M.
        • Federico A.
        • Biscione A.
        • Vizzielli G.
        • et al.
        Robotic surgery in elderly and very elderly gynecologic Cancer patients.
        J Minim Invasive Gynecol. 2018; 25: 872-877
        • Lavoue V.
        • Gotlieb W.
        Benefits of minimal access surgery in elderly patients with pelvic Cancer.
        Cancers (Basel). 2016; 8
        • Turrentine F.E.
        • Wang H.
        • Simpson V.B.
        • Jones R.S.
        Surgical risk factors, morbidity, and mortality in elderly patients.
        J Am Coll Surg. 2006; 203: 865-877
        • Nelson G.
        • Kalogera E.
        • Dowdy S.C.
        Enhanced recovery pathways in gynecologic oncology.
        Gynecol Oncol. 2014; 135 (Review): 586-594
        • Nelson G.
        • Bakkum-Gamez J.
        • Kalogera E.
        • Glaser G.
        • Altman A.
        Meyer LA at al. Guidelines for perioperative care in gynecologic/oncology: enhanced Recovery after Surgery (ERAS) Society recommendations-2019 update.
        Int J Gynecol Cancer. 2019;
        • Nordin A.J.
        • Chinn D.J.
        • Moloney I.
        • Naik R.
        • de Barros Lopes A.
        • Monaghan J.M.
        Do elderly cancer patients care about cure? Attitudes to radical gynecologic oncology surgery in the elderly.
        Gynecol Oncol. 2001; 81: 447-455
        • Extermann M.
        • Hurria A.
        Comprehensive geriatric assessment for older patients with Cancer.
        J Clin Oncol. 2007; 25: 1824-1831
        • Hurria A.
        • Gupta S.
        • Zauderer M.
        • et al.
        Developing a cancer-specific geriatric assessment: a feasibility study.
        Cancer. 2005; 104
        • Wildiers H.
        • Heeren P.
        • Puts M.
        • Topinkova E.
        • Janssen-Heijnen M.L.
        • Extermann M.
        • et al.
        International Society of Geriatric Oncology consensus on geriatric assessment in older patientswith cancer.
        J Clin Oncol. 2014; 32: 2595-2603
        • Fried L.P.
        • Tangen C.M.
        • Walston J.
        • et al.
        Frailty in older adults: evidence for a phenotype.
        J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
        • Molina M.J.
        • Oncogeriatría Guillén C.
        Una forma de optimizar la atención global del paciente anciano con cáncer.
        Nutr Hosp. 2016; 33: 31-39
        • Chaïbi P.
        • Magné N.
        • Breton S.
        • Chebib A.
        • W atson S.
        • Duron J.J.
        • et al.
        Influence of geriatric consultation with comprehensive geriatric assessment on final therapeutic decision in elderly cancer patients.
        Crit Rev Oncol Hematol. 2011; 79: 302-307
        • Girre V.
        • Falcou M.C.
        • Gisselbrecht M.
        • Gridel G.
        • Mosseri V.
        • Bouleuc C.
        • et al.
        Does a geriatric oncology consultation modify the cancer treatment plan for elderly patients?.
        J Gerontol A Biol Sci Med Sci. 2008; 63: 724-730
        • Shahrokni A.
        • Vishnevsky B.M.
        • Jang B.
        • Sarraf S.
        • Alexander K.
        • Kim S.J.
        • et al.
        Geriatric assessment, not ASA physical status, is associated with 6-Month postoperative survival in patients with Cancer Aged ≥75 years.
        J Natl Compr Canc Netw. 2019; 17: 687-694
        • Soubeyran P
        • Bellera C
        • Goyard J
        • Heitz D
        • Curé H
        • Rousselot H
        • et al.
        Screening for vulnerability in older cancer patients: the ONCODAGE prospective multicenter cohort study.
        PLoS One. 2014; 9
        • Maione P.
        • Perrone F.
        • Gallo C.
        • Manzione L.
        • Piantedosi F.
        • Barbera S.
        • et al.
        Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study.
        J Clin Oncol. 2005; 23: 6865-6872
        • Pardal E.
        • Díez Baeza E.
        • Salas Q.
        • García T.
        • Sancho J.M.
        • Monzón E.
        • et al.
        GELTAMO Spanish Collaborative Group. A new prognostic model identifies patients aged 80 years and older with diffuse large B-cell lymphoma who may benefit from curative treatment: a multicenter, retrospective analysis by the Spanish GELTAMO group.
        Am J Hematol. 2018; 93: 867-873
        • Courtney-Brooks M.
        • Tellawi A.R.
        • Scalici J.
        • Duska L.R.
        • Jazaeri A.A.
        • Modesitt S.C.
        • et al.
        Frailty: an outcome predictor for elderly gynecologic oncology patients.
        Gynecol Oncol. 2012; 126: 20-24
        • Kumar A.
        • Langstraat C.L.
        • DeJong S.R.
        • McGree M.E.
        • Bakkum-Gamez J.N.
        • Weaver A.L.
        • et al.
        Functional not chronologic age: frailty index predicts outcomes in advanced ovarian cancer.
        Gynecol Oncol. 2017; 147: 104-109
        • Duska L.
        • Shahrokni A.
        • Powell M.
        Treatment of older women with endometrial Cancer: improving outcomes with personalized care.
        Am Soc Clin Oncol Educ Book. 2016; 35: 164-174
        • Ferguson S.E.
        • Panzarella T.
        • Lau S.
        • Gien L.T.
        • Samouëlian V.
        • Giede C.
        • et al.
        Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer.
        Gynecol Oncol. 2018; 149: 476-483
        • Shisler R.
        • Sinnott J.A.
        • Wang V.
        • Hebert C.
        • Salani R.
        • Felix A.S.
        Life after endometrial cancer: a systematic review of patient-reported outcomes.
        Gynecol Oncol. 2018; 148: 403-413
        • Dobrzycka B.
        • Terlikowski R.
        • Kulesza-Brończyk B.
        • Niklinski J.
        • Terlikowsk S.J.
        Quality of life in long-term survivors of early stage endometrial cancer.
        Ann Agric Environ Med. 2017; 24: 513-516