title: The effects of age and comorbidity on treatment and outcomes in women with endometrial cancer.
abstract: BACKGROUND
  Although the incidence of endometrial cancer increases with age, the effect of patient age on treatment selection and outcomes is unclear. In addition, although aging is associated with increased prevalence of comorbid conditions, the extent to which comorbidities influence endometrial cancer management is not well documented.
  
  
  METHODS
  This population-based analysis evaluates the effect of age and comorbidity on endometrial cancer treatment and outcome in a cohort of 401 patients referred to the Vancouver Island Centre, British Columbia Cancer Agency from 1989 to 1996. Treatment and 5-year actuarial overall survival (OS) and disease-free survival (DFS) were compared by age at diagnosis (<65, 65-74, and > or =75 years) and comorbidity index (Charlson score 0-1 and > or =2).
  
  
  RESULTS
  Median follow-up time was 7.8 years. In this cohort, 148 (37%), 152 (38%), and 101 (25%) were aged <65, 65-74, and > or =75 years, respectively. Charlson comorbidity scores > or =2 were found in 18% of patients. Distributions of disease stage, tumor characteristics, and surgical therapy were similar across age and comorbidity subgroups. Standard surgery in this cohort comprised hysterectomy without routine lymphadenectomy. In stage Ic disease, the use of postoperative RT declined with advanced age (96%, 97%, and 74% in patients aged <65, 65-74, and > or =75 years, respectively, P = 0.05) and with increased comorbidities (91% and 79% in patients with Charlson score 0-1 and > or =2, respectively, P = 0.07). Among stage Ic patients aged > or =75 years, pelvic/vaginal relapse occurred in 2 of 6 patients treated with hysterectomy alone compared with 0 of 20 patients treated with postoperative radiotherapy (P = 0.006). On multivariable Cox modeling, age at diagnosis, performance status, stage, grade, lymphovascular invasion, surgery, and radiotherapy use, but not Charlson comorbidity score, were significant predictors for overall survival.
  
  
  CONCLUSIONS
  Although surgical therapy for endometrial cancer was not influenced by age or comorbidities, reduced use of postoperative radiotherapy in stage Ic disease was observed among women with advanced age and high comorbidity index. The associated pelvic/vaginal relapse rates were higher in elderly patients not treated with radiotherapy. Chronologic age alone should not preclude patients from consideration of optimal local therapy.
authors.affiliation: Radiation Therapy Program, British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, Canada. ptruong@bccancer.bc.ca
authors.forename: Pauline T
authors.initials: PT
authors.lastname: Truong
authors.forename: Hosam A
authors.initials: HA
authors.lastname: Kader
authors.forename: Barbara
authors.initials: B
authors.lastname: Lacy
authors.forename: Mary
authors.initials: M
authors.lastname: Lesperance
authors.forename: Mary V
authors.initials: MV
authors.lastname: MacNeil
authors.forename: Eric
authors.initials: E
authors.lastname: Berthelet
authors.forename: Elissa
authors.initials: E
authors.lastname: McMurtrie
authors.forename: Skaria
authors.initials: S
authors.lastname: Alexander
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome