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

Author

Violante Di Donato, Dionyssios Katsaros, Nicoletta Donadello, Giorgia Mangili, Giovanni Scambia, Francesco Raspagliesi, Roldano Fossati, Costantino Mangioni, Elio Campagnutta, Claudia Marchetti, Antonio Palagiano, Andrea Lissoni, Stefano Greggi, Valter Torri, Mauro Melpignano, Roberto Grassi, Gennaro Cormio, Clara Crocè, Mauro Signorelli, Pierluigi Benedetti Panici, Massimo Franchi, Saverio Tateo, Francesco Maneschi, Diana Giannarelli, Alessandra Perutelli, Stefano Basile, Maria Giovanna Salerno, Giorgia Perniola, Benedetti Panici, P, Basile, S, Salerno, M, Di Donato, V, Marchetti, C, Perniola, G, Palagiano, A, Perutelli, A, Maneschi, F, Lissoni, A, Signorelli, M, Scambia, G, Tateo, S, Mangili, G, Katsaros, D, Campagnutta, E, Donadello, N, Greggi, S, Melpignano, M, Raspagliesi, F, Cormio, G, Grassi, R, Franchi, M, Giannarelli, D, Fossati, R, Torri, V, Crocè, C, Mangioni, C, Salerno, Mg, Lissoni, Aa, Grassi, Roberto, and Mangioni, C.

Subjects
Oncology, Kaplan-Meier Estimate, law.invention, Body Mass Index, Randomized controlled trial, Older patients, law, Medicine, Age Factor, Stage (cooking), Neoplasm Metastasis, prognostic factor, Multivariate Analysi, education.field_of_study, Age Factors, Obstetrics and Gynecology, Prognosis, Combined Modality Therapy, Neoplasm Metastasi, Lymphatic Metastasis, Obesity, Abdominal, Female, endometrial carcinoma, Human, medicine.medical_specialty, Prognostic factor, Prognosi, Population, Internal medicine, Carcinoma, Humans, Endometrial Neoplasm, education, Aged, Neoplasm Staging, Settore MED/06 - ONCOLOGIA MEDICA, business.industry, prognostic factors, Lymphatic Metastasi, medicine.disease, Obesity, Endometrial Neoplasms, Settore MED/40 - GINECOLOGIA E OSTETRICIA, age, body mass index, Multivariate Analysis, Lymph Node Excision, Neoplasm Grading, Neoplasm Recurrence, Local, business, Body mass index
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.

Published
2013

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