The effects of age on treatment and outcomes in women with stages IB1-IIB cervical cancer.
OBJECTIVE
Age may affect the treatment choice and subsequent outcome in elderly patients with cervical cancer. Given the potential for cure with either surgery or chemoradiation in early stage disease, we aimed to determine whether a patient's age influenced treatment received and the ensuing outcome.


METHODS
We identified 303 patients with stages IB1-IIB cervical carcinoma treated at our institution between 2000 and 2010, who were divided into two groups based on age at time of diagnosis: < 65 and ≥ 65 years. Adjusted odd ratios were calculated to determine variables associated with treatment received. Single and multivariate Cox proportional hazards modeling were used to estimate hazard ratios (HRs) for variables associated with disease-specific survival.


RESULTS
Patients were more commonly <65 years at diagnosis (83% versus 17% ≥ 65 years). There was no difference between the two groups in terms of tumor histology, stage at presentation, and grade. Women ≥ 65 years of age were less likely to receive primary surgical management (p=0.03). Age did not influence disease-specific or all-cause mortality. However, women over 65 years who underwent primary surgery were at significantly increased risk of all-cause mortality compared to younger women (HR 6.53, 95% CI: 2.57-16.6).


CONCLUSIONS
Age appears to influence treatment received by patients with stages IB1-IIB cervical cancer. Although there was no difference in cancer-specific mortality stratified by type of treatment received, surgery was associated with a 6.5-fold increased risk of all-cause mortality among women 65 years or over.
The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA. Electronic address: droque@wihri.org.
Dario R
DR
Roque
The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA. Electronic address: bcronin@wihri.org.
Beth
B
Cronin
The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Obstetrics and Gynecology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Program in Women's Oncology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA. Electronic address: krobison@wihri.org.
Katina
K
Robison
Division of Researcxh, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA. Electronic address: vlopes@wihri.org.
Vrishali
V
Lopes
The Warren Alpert Medical School of Brown University, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Program in Women's Oncology, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA; Department of Medicine, Women & Infants Hospital, 101 Dudley Street, Providence, RI 02906, USA. Electronic address: trizack@wihri.org.
Tina
T
Rizack
Medical Gynecologic Oncology Service, Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: ddizon@partners.org.
Don S
DS
Dizon
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D055815:Young Adult
Cervical cancer; Elderly; Treatment allocation