title: Lack of improvement in survival rates for women under 50 with endometrial cancer, 2000-2011.
abstract: OBJECTIVE
  To assess how first course of treatment affects cancer-specific survival in women diagnosed with endometrial cancer younger than 50 years old.
  
  
  METHODS
  Public-use data from the Surveillance, Epidemiology, and End Results program were used. The study included 82,721 women diagnosed with primary, invasive endometrial cancer between 2000 and 2011. We assessed type of treatment using Cox's proportional hazards models to determine survival disparity by age and stage.
  
  
  RESULTS
  Cancer-specific survival significantly improved for those aged ≥50 years with late stage, but did not improve for those <50. First course of treatment significantly affected cancer-specific survival for endometrial cancer patients. Regardless of age, survival was greatly improved for late-stage patients who received a combination of surgery and radiation [hazard ratio (HR) 0.62 [95 % confidence interval (CI) 0.47-0.78] and 0.64 (95 % CI 0.59-0.68)] compared to those who received total hysterectomy with removal of ovaries and tubes. However, the proportion of patients who received combination therapy decreased over time. The magnitude of decrease was larger in patients <50 than in those aged ≥50. Overall, about 24-57 % of the difference in cancer-specific survival over time in patients aged <50 was explained by their initial treatment.
  
  
  CONCLUSIONS
  Improvement in cancer-specific survival was only seen in older women with late-stage diagnosis. Despite improvements in diagnoses and treatments, the difference in age-specific survival indicates that more should be done to understand why these rates are not improving for those younger than 50 years old.
authors.affiliation: Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555-0587, USA. an3rodri@utmb.edu.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Rodriguez
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.affiliation: Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555-1148, USA.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
mesh_terms: D000328:Adult; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Age; Age-specific survival; Endometrial cancer; SEER; Treatment