Potential competing risk of death in older high-risk endometrial carcinoma patients: Results from a multicentric retrospective cohort

Violaine Gorgeu, Bruno Borghese, Meriem Koual, Pierre Alexandre Just, Marie Aude Lefrere Belda, Nicolas Delanoy, Catherine Durdux, Charles Chapron, François Goldwasser, Claire Gervais, Helene Blons, Benoit Terris, Cécile Badoual, Valerie Taly, Pierre Laurent-Puig, Anne Sophie Bats, Jérôme Alexandre, Guillaume Beinse

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Résumé

Introduction: Adjuvant therapeutic decisions in older endometrial carcinoma (EC) patients are challenged by a balance between more frequent aggressive EC and comorbidities. We assessed whether EC and comorbidities are competing or cumulative risks in older EC patients. Methods: All consecutive patients treated for FIGO stage I-IV EC in two University Hospitals in Paris between 2010 and 2017 were retrospectively included. Patients were categorized as: <70 years (y), >70y without comorbidity (fit), and > 70y with a Charlson comorbidity index>3 (comorbid). Association between high-risk EC (2021-ESGO-ETRO-ESP) or comorbidity, and disease-specific-survival (DSS), was evaluated using Cox model (estimation of cause-specific hazard ratio (CSHR), and Fine-Gray model (subdistribution HR) to account for competing events (death unrelated with EC). Results: Overall, 253 patients were included (median age = 67y, IQR[59–77], median follow-up = 61.5 months, [44.4–76.8]). Among them, 109 (43%) were categorized at high-risk (proportion independent of age), including 67 (26%) who had TP53-mutated tumors. Comorbidity and high-risk group were both associated with all-cause mortality (HR = 4.09, 95%CI[2.29; 7.32] and HR = 3.21, 95%CI [1.69; 6.09], respectively). By multivariate analysis, patients with high-risk EC exhibited poorer DSS, regardless of age/comorbidity (Adjusted-CSHR = 6.62, 95%CI[2.53;17.3]; adjusted-SHR = 6.62 95%CI[2.50;17.5]). Patients>70y-comorbid with high-risk EC had 5-years cumulative incidences of EC-related and EC-unrelated death of 29% and 19%, respectively. In patients <70y, 5-years cumulative incidence of EC-related and EC-unrelated death were 25% and < 1% (one event), respectively. Conclusion: High-risk EC patients are exposed to poorer DSS regardless of age/comorbidities, comorbidities and cancer being two cumulative rather than competing risks. Our results suggest that age/comorbidity alone should not lead to underestimate EC-specific survival.

langue originaleAnglais
Pages (de - à)269-276
Nombre de pages8
journalGynecologic Oncology
Volume166
Numéro de publication2
Les DOIs
étatPublié - 1 août 2022
Modification externeOui

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