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

• Published in: Gynecologic oncology 2022-08, Vol.166 (2), p.269-276
• Main Authors: Gorgeu, Violaine, Borghese, Bruno, Koual, Meriem, Just, Pierre-Alexandre, Lefrere Belda, Marie-Aude, Delanoy, Nicolas, Durdux, Catherine, Chapron, Charles, Goldwasser, François, Gervais, Claire, Blons, Helene, Terris, Benoit, Badoual, Cécile, Taly, Valerie, Laurent-Puig, Pierre, Bats, Anne-Sophie, Alexandre, Jérôme, Beinse, Guillaume
• Format: Article
• Language: English
• Subjects: Life Sciences
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2022.05.016

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: 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