Impact of Neoadjuvant Chemotherapy on Survival Outcome in Advanced Stage Endometrial Cancer in Octogenarians vs Non-Octogenarians
Abstract
Introduction and Objective. Endometrial cancer (EC) is predominantly seen in older women, with the median age at diagnosis 61 years. The incidence of EC has increased by 1% annually, partly due to an ageing population with better access to healthcare. However, elderly women including octogenarians (aged 80 and above) with advanced stage endometrial cancer (ASEC) are less likely to receive the same level of treatment as their younger counterparts (1). Octogenarian patients may be less likely to undergo chemotherapy due to their comorbidities and poor quality of life. Therefore, this study seeks to compare the survival outcomes of octogenarian vs non-octogenarian patients receiving neoadjuvant chemotherapy and cytoreductive therapy. Methods. This retrospective study utilized the National Cancer Database between 2004 and 2020, focusing on individuals diagnosed with ASEC (clinical FIGO stage III and IV) who received neoadjuvant chemotherapy followed by cytoreductive surgery. Our primary analytic cohort consisted of two arms: the octogenarians (OG) and the non-octogenarians (NOG). Exploratory analysis for demographic variables such as race, ethnicity, facility type, median income, insurance, comorbidity score, and FIGO stage were done using Chi-square analysis. Kaplan-Meier survival analysis was performed to analyze the overall survival outcomes between the OG and NOG arms. Results. Of the initial 49,613 individuals diagnosed with ASEC, 5850 (11.8) were octogenarians (OG) and 43763 (88.2) were non-octogenarians (NOG). The proportion of patients who received chemotherapy between OG and NOG groups was 3.9% vs 10.9% and 14.5% vs 35% for the NACT and ACT groups, respectively (p < 0.001). The median overall survival in the OG arm was 23.98 months (95%CI: 21.45-26.51, p < 0.001), compared to 32.23 months (95%CI: 30.79-33.67, p < 0.001) in the NOG arm. Conclusions-Implications. This study found that amongst individuals diagnosed with ASEC (FIGO stage III and IV) receiving neoadjuvant chemotherapy and cytoreductive surgery, octogenarians had poorer overall survival compared to non-octogenarians. While additional studies are necessary to validate this finding, this information may be valuable for treatment planning and facilitating shared decision-making.
Abstract Category
22. Oncology
Secondary Abstract Category
21. Obstetrics & Gynecology
Keywords
endometrial cancer, neoadjuvant therapy, octogenarian
Presentation Type
Poster Presentation
Impact of Neoadjuvant Chemotherapy on Survival Outcome in Advanced Stage Endometrial Cancer in Octogenarians vs Non-Octogenarians
Introduction and Objective. Endometrial cancer (EC) is predominantly seen in older women, with the median age at diagnosis 61 years. The incidence of EC has increased by 1% annually, partly due to an ageing population with better access to healthcare. However, elderly women including octogenarians (aged 80 and above) with advanced stage endometrial cancer (ASEC) are less likely to receive the same level of treatment as their younger counterparts (1). Octogenarian patients may be less likely to undergo chemotherapy due to their comorbidities and poor quality of life. Therefore, this study seeks to compare the survival outcomes of octogenarian vs non-octogenarian patients receiving neoadjuvant chemotherapy and cytoreductive therapy. Methods. This retrospective study utilized the National Cancer Database between 2004 and 2020, focusing on individuals diagnosed with ASEC (clinical FIGO stage III and IV) who received neoadjuvant chemotherapy followed by cytoreductive surgery. Our primary analytic cohort consisted of two arms: the octogenarians (OG) and the non-octogenarians (NOG). Exploratory analysis for demographic variables such as race, ethnicity, facility type, median income, insurance, comorbidity score, and FIGO stage were done using Chi-square analysis. Kaplan-Meier survival analysis was performed to analyze the overall survival outcomes between the OG and NOG arms. Results. Of the initial 49,613 individuals diagnosed with ASEC, 5850 (11.8) were octogenarians (OG) and 43763 (88.2) were non-octogenarians (NOG). The proportion of patients who received chemotherapy between OG and NOG groups was 3.9% vs 10.9% and 14.5% vs 35% for the NACT and ACT groups, respectively (p < 0.001). The median overall survival in the OG arm was 23.98 months (95%CI: 21.45-26.51, p < 0.001), compared to 32.23 months (95%CI: 30.79-33.67, p < 0.001) in the NOG arm. Conclusions-Implications. This study found that amongst individuals diagnosed with ASEC (FIGO stage III and IV) receiving neoadjuvant chemotherapy and cytoreductive surgery, octogenarians had poorer overall survival compared to non-octogenarians. While additional studies are necessary to validate this finding, this information may be valuable for treatment planning and facilitating shared decision-making.