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Research Paper|Volume 13, Issue 15|pp 19561—19574

Effect of age as a continuous variable in early-stage endometrial carcinoma: a multi-institutional analysis in China

Shuai Sun1, Lijuan Zou3, Tiejun Wang4, Zi Liu5, Jianli He6, Xiaoge Sun7, Wei Zhong8, Fengju Zhao9, Xiaomei Li10, Sha Li11, Hong Zhu12, Zhanshu Ma13, Wenhui Wang1, Meng Jin14, Fuquan Zhang1, Xiaorong Hou1, Lichun Wei2, Ke Hu1
  • 1Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
  • 2Department of Radiation Oncology, Xijing Hospital, Air Force Medical University of PLA (The Fourth Military Medical University), Xi’an, P.R. China
  • 3Department of Radiation Oncology, The Second Hospital of Dalian Medical University, Dalian, P.R. China
  • 4Department of Radiation Oncology, The Second Hospital Affiliated by Jilin University, Changchun, P.R. China
  • 5Department of Radiation Oncology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
  • 6Department of Radiation Oncology, The General Hospital of Ningxia Medical University, Ningxia, P.R. China
  • 7Department of Radiation Oncology, The Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, P.R. China
  • 8Gynaecological Oncology Radiotherapy, Affiliated Tumor Hospital, Xinjiang Medical University, Urumqi, P.R. China
  • 9Department of Radiation Oncology, Gansu Provincial Cancer Hospital, Lanzhou, Gansu, P.R. China
  • 10Department of Radiation Oncology, Peking University First Hospital, Beijing, P.R. China
  • 11Department of Radiation Oncology, The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, Gansu, P.R. China
  • 12Department of Radiation Oncology, Xiangya Hospital Central South University, Hunan, P.R. China
  • 13Department of Radiation Oncology, Affiliated Hospital of Chi feng University, Inner Mongolia, P.R. China
  • 14Department of Radiation Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
* Equal contribution
Received: February 10, 2021Accepted: July 15, 2021Published: August 9, 2021
https://doi.org/10.18632/aging.203367

Copyright: © 2021 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Objective: To explore the effect of age at diagnosis as a continuous variable on survival and treatment choice of patients with early-stage endometrial carcinoma (EC).

Materials and Methods: We retrospectively analyzed data from patients with early-stage EC from January 1999 to December 2015 in multiple institutions in China. All patients received primary hysterectomy/bilateral salpingo-oophorectomy and adjuvant radiotherapy for EC confirmed pathology of stage I and II disease (FIGO 2009 staging). All patients were divided into low-risk, intermediate-risk, high-intermediate-risk and high-risk groups according to ESMO-ESGO-ESTRO risk classification.

Results: The median follow-up time was 57months, and the 5-year cancer-specific survival (CSS) was 95.7%. Age as a continuous variable was an independent prognostic factor for CSS. With an increase in age, the hazard ratio (HR) for CSS increases gradually. Other independent prognostic factors included myometrial invasion (MI), grade, and chemotherapy. In the stratified analysis of age, the HRs of age on CSS in patients >70y were 5.516, 5.015, 4.469, 4.618, 5.334, and 5.821 after adjusting for cancer characteristics, local treatment, chemotherapy and treatment-related late toxicity. In patients 66-70-year-old, the HRs were 2.509, 2.074, 2.101, 2.091, 2.157 and 1.621 after adjusting for the above covariates. In patients ≤65y, there was no significant difference in the HR of age on CSS after adjustment.

Conclusion: Age as a continuous variable is an independent prognostic factor and 65 year-old may be the best cut-off point for CSS in patients with early-stage EC in the Asian population. Quality of life should be given greater weight in the choice of therapeutic schedule for those patients >70 y.