Survival and prognosis of women with invasive cervical cancer according to age.
OBJECTIVE
We assessed survival and compared clinical and pathological prognostic factors of women with invasive cervical cancer according to the age in order to define a cutoff point where screening should become useless.


METHODS
The survival of 308 women with invasive cervical cancer treated at Bordeaux University Hospital between 1976 and 1996 was evaluated on December 31, 2000. Kaplan-Meier survival curves calculated with regard to age were compared by the log-rank test. Prognostic factors were assessed according to age (cutoff 65 years) and included in a Cox model. Survival of women in our population within a particular age group was compared to survival of women of the same age range, using indirect standardization.


RESULTS
The 5-year survival rate of women under 65 (n = 221), between 65 and 74 (n = 56), and over 75 (n = 31) was 75%, 69%, 42%, respectively (P < 0.001). Compared to women under 65, women over 65 had a significantly lower Karnofsky performance status and a significantly more advanced clinical stage cancer involving vaginal bleeding. Age, gross cervical appearance, clinical vaginal involvement, histologic grade, and microscopic cervical and parametrial involvements were independent prognostic factors. Compared to women under 65, the risk of mortality was 1.3, 95% CI = 0.8-2.7, P = 0.189, for women aged 65-74, and 2.3, 95% CI = 1.1-3.9, P = 0.022, for women over 75. Mortality of women with invasive cervical cancer was significantly higher than that of women in the general population in the indirect standardization model (SMR = 1.9, 95% CI = 1.5-2.2), except beyond age 75.


CONCLUSIONS
Age was a significant prognostic factor in our study and advanced stages were significantly increased after 65. However, survival after 75 was not different from that of the population. These considerations address the question of the maintenance of screening between 65 and 75.
Department of Gynecology, University Hospital, Bordeaux, France. jean-luc.brun@chu-bordeaux.fr
Jean Luc
JL
Brun
Dorothée
D
Stoven-Camou
Renaud
R
Trouette
Malika
M
Lopez
Geneviève
G
Chene
Claude
C
Hocké
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology