Are older women with early-stage endometrial cancer undertreated and more likely to die from their cancer?
Endometrial cancer is the most common gynecological malignancy in developed countries, mainly affecting older women and raising concerns about potential under-treatment. This study aimed to describe treatment patterns and assess net survival in older women with early-stage endometrial cancer. This French retrospective observational study used a gynecological cancer registry. Patients diagnosed with FIGO I-II endometrial cancer from 1998 to 2018 were included and stratified by age (a younger group, under 70 years, and an older group, aged 70 years or more). A multiple penalized splines model was used. A total of 828 patients were included: 448 women aged under 70 and 380 aged 70 or more. Older patients belonged to higher-risk groups as defined by ESGO-ESTRO-ESP 2021 criteria (p < 0.001) and had a lower rate of low-grade endometrioid carcinoma (75.1 % vs. 85.7 %, p = 0.003). Treatment patterns did not differ by age; surgery plus adjuvant therapy remained the main treatment (69.7 % vs. 70.8 % in the older and younger groups, respectively, p = 0.87). 5-year net survival was 95.0 % (95 % CI: 92.6-97.6) for younger and 84.3 % (95 % CI: 78.8-90.3) for older women. The univariate hazard ratio for death in older vs. younger women was 2.38 (95 % CI: 1.19-4.74; p = 0.02). Multivariate analysis attenuated age's effect: hazard ratio 1.38 (95 % CI: 0.97-3.31; p = 0.06). Charlson Comorbidity Index and non-low-grade endometrioid histology predicted poorer survival. Diagnosis period was not associated with survival. No significant difference in treatment was found according to age. Although age was associated with 5-year net survival in univariate analysis, this association was no longer observed after adjusting for diagnosis period, comorbidities, and histology.