title: Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
authors.affiliation: Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. Electronic address: s.basile@ao-pisa.toscana.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Basile
authors.affiliation: Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Salerno
authors.affiliation: Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy.
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.affiliation: Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Marchetti
authors.affiliation: Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Perniola
authors.affiliation: Department of Obstetrics and Gynecology, Sapienza University Hospital, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Palagiano
authors.affiliation: Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Perutelli
authors.affiliation: Department of Obstetrics and Gynecology, S. Maria Goretti Hospital, Latina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maneschi
authors.affiliation: Department of Obstetrics and Gynecology, S. Gerardo Hospital, Monza, Italy.
authors.forename: Andrea Alberto
authors.initials: AA
authors.lastname: Lissoni
authors.affiliation: Department of Obstetrics and Gynecology, S. Gerardo Hospital, Monza, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: Department of Obstetrics and Gynecology, Gemelli Hospital, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
authors.affiliation: Department of Obstetrics and Gynecology, Fondazione Policlinico S. Matteo Pavia, Milan, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Tateo
authors.affiliation: Department of Obstetrics and Gynecology, S. Raffaele Hospital, Milan, Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.affiliation: Department of Obstetrics and Gynecology, S. Anna Hospital, Turin, Italy.
authors.forename: Dionyssios
authors.initials: D
authors.lastname: Katsaros
authors.affiliation: Department of Obstetrics and Gynecology, Aviano Hospital, Aviano, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Campagnutta
authors.affiliation: Department of Obstetrics and Gynecology, University of Varese, Varese, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Donadello
authors.affiliation: Department of Obstetrics and Gynecology, Istituto Nazionale Tumori, Fondazione G. Pascale, Naples, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Greggi
authors.affiliation: Department of Obstetrics and Gynecology, Parma University Hospital, Parma, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Melpignano
authors.affiliation: Department of Obstetrics and Gynecology, Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
authors.affiliation: Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Cormio
authors.affiliation: Department of Obstetrics and Gynecology, Treviglio Hospital, Treviglio, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Grassi
authors.affiliation: Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Franchi
authors.affiliation: Department of Obstetrics and Gynecology, IFO-Istituto Regina Elena, Rome, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.affiliation: Department of Obstetrics and Gynecology, Mario Negri Institute, Milan, Italy.
authors.forename: Roldano
authors.initials: R
authors.lastname: Fossati
authors.affiliation: Department of Obstetrics and Gynecology, Mario Negri Institute, Milan, Italy.
authors.forename: Valter
authors.initials: V
authors.lastname: Torri
authors.affiliation: Department of Obstetrics and Gynecology, Northeast Women's Health and Obstetrics, Concord, NC.
authors.forename: Clara
authors.initials: C
authors.lastname: Crocè
authors.affiliation: Department of Obstetrics and Gynecology, S. Gerardo Hospital, Monza, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Mangioni
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D056128:Obesity, Abdominal / Q000453:epidemiology; D011379:Prognosis
keywords: age; body mass index; endometrial carcinoma; prognostic factors