Endometrioid Endometrial Adenocarcinoma (EEA) in Elderly Women: A Clinico-Pathologic Study
S Hafezi, S Nofech-Mozes, N Ismiil, V Dube, RS Saad, Z Ghorab, MA Khalifa. Sunnybrook Health Sciences Centre, Toronto, ON, Canada
Background: EEA accounts for 80% of all endometrial malignancies, is usually diagnosed at an early stage and is associated with favorable prognosis. With increased life expectancy, it is likely that more women will be diagnosed with endometrial cancer at an older age. The clinico-pathologic features that affect adjuvant therapy and prognosis have not been well characterized in elderly women as a recognized subgroup. Typically, this subset of patients has more co-morbidities that potentially impact their treatment. In this study, we compared the outcomes and histopathologic prognosticators of EEA in women 70 or older to those of younger patients.
Design: Between 1999-2004, 825 patients were diagnosed with EEA in our hospital. Cases were divided into two groups: elderly women (age 70, n=242) and younger women (age<70, n=583). Follow up and pathologic data [tumor grade, stage, depth of myometrial invasion, cervical involvement, lymphovascular invasion (LVI), lymph node status] were retrieved. Chi square and Fisher exact test were used to compare differences for categorical variables and t test was used to examine differences between means.
Results: EAA in the elderly group was associated with lower proportion of grade 1 tumors (54.5% vs 63.1%; P=0.02), and higher proportions of deep myometrial invasion (41.3% vs 25.3%; P<0.0002), extra-uterine disease (26.8% vs 20.5%; P=0.04) and LVI (30.1% vs18.6%; P=0.0003). We found a trend toward higher rate of cervical involvement in women 70 (22.6% vs19.5%); however, this was not statistically significant (p=0.303). The likelihood of having surgical staging was comparable in both groups (90% vs 89.5%) but the proportion of positive lymph nodes was significantly higher in the elderly group (29.1% vs 9.8%; P=0.02). With a mean follow-up of 54 25.5 months in elderly women and 65 26.8 months in younger patients, the rate of local recurrence was significantly higher in former group (8.2% vs 3.9%; P=0.01). The difference in rates of distant recurrence was not significant. Time to recurrence was shorter in elderly patients (mean of 17.1 1 m vs 20.72 16 m).
Conclusions: In our experience, endometrial cancer in elderly women is characterized by increased proportion of FIGO grade 2 or 3 tumors and more advanced disease at the time of diagnosis. Moreover, elderly patients are at greater risk of local recurrence. These findings could affect future strategies in management of EAA in this subset of patients.
Monday, March 9, 2009 9:30 AM
Poster Session I Stowell-Orbison/Autopsy Award # 151, Monday Morning