Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome

Objective: Despite the fact that endometrial cancer commonly occurs in elderly women, little is known about the outcome of the oldest old, those > 80 years of age. We examined the patterns of care and outcome of the oldest old women with endometrial cancer. Methods: An analysis of women > 65 years of age with endometrioid adenocarcinoma of the uterus diagnosed between 1988 and 2006 and registered in the Surveillance, Epidemiology, and End Results database was performed. Patients were stratified by age into the following groups: 65-69, 70-74, 75-79, 80-84, and ≥ 85 years of age. Multivariable logistic regression models were constructed to examine treatment while adjusting for other confounders. Cancer-specific survival was examined using Cox proportional hazards models. Results: A total of 37,718 women including 5289 aged 80-84 and 3446 ≥ 85 years of age were identified. Older women had higher grade tumors (p < 0.0001) and more advanced stage disease (p < 0.0001). After adjusting for tumor characteristics, patients ≥ 85 years of age were less likely to undergo hysterectomy (OR = 0.14; 95% CI = 0.12-0.16) and lymphadenectomy (OR = 0.48; 95% CI = 0.44-0.54) and less likely to receive radiation (OR = 0.41; 95% CI = 0.36-0.46). After adjustment for treatment and prognostic factors, cancer-specific mortality was 53% (HR = 1.53; 95% CI = 1.39-1.67) greater in women 80-84 and 89% (HR = 1.89; 95% CI = 1.71-2.08) greater in those ≥ 85 years of age than in women 65-69 years old. Conclusion: Women > 80 years of age receive less aggressive care than younger women. Even after adjusting for treatment differences, cancer-specific mortality is higher in the oldest old women.