Recurrence and Characteristics of Endometrial Cancer In Elderly Patients

Yıl 2024, Cilt: 10 Sayı: 3, 494 - 499, 19.09.2024

Varol Gülseren , Zübeyde Emiralioğlu Çakır , Muzaffer Sancı , Aykut Özcan , Oğuzhan Kuru , İlker Çakır , Mehmet Gökçü , İsa Aykut Özdemir , Kemal Güngördük

https://doi.org/10.53394/akd.1339147

Öz

Aim: In this study, evaluated the treatment options of patients of advanced age (≥70 years) with recurrence, survival results were analyzed.
Methods: The data of patients diagnosed with endometrial cancer (EC) in the Gynecological Oncology Clinic between 2001 and 2020 were evaluated retrospectively. Seventy six cases with advanced age and relapse were evaluated. Patients who underwent hysterectomy surgery in our center and continued their follow-up regularly were included in the study.
Results: The mean age at the time of recurrence was 74.6 ± 3.9 years. The endometrioid type, seen in half of the patients, was the most common histological type. Pelvic paraaortic lymph node (LN) sampling/dissection was performed in 84.2% of the patients. Deep myometrial invasion was detected in 56 (73.7%) patients, and LVSI was found in 42 (56.8%) patients. The mean time to recurrence was found to be 25.1 ± 17.8 months. Total survival times were calculated as 47.2 ± 28.2 months. The five-year overall survival (OS) rate was analyzed as 35.7%. The most common site of recurrence was lung, and isolated lung recurrence was seen in 14 (18.5%) patients. There was no significant difference for OS among patients with pelvic recurrence and extra-pelvic/multiple recurrences (P= 0.723).
Conclusion: Survival outcomes in recurrences are worse in advanced age endometrial cancer patients. This may be due to more limited treatment options for recurrence due to additional internal problems.

Anahtar Kelimeler

Endometrial cancer, Elderly patients, Recurrence, Lymph node

Yaşlı Hastalarda Endometriyal Kanser Nüksü ve Özellikleri

Öz

Amaç: Bu çalışmada nüks ile seyreden ileri yaş (≥70 yaş) hastaların tedavi seçenekleri değerlendirildi, sağkalım sonuçları analiz edildi.
Yöntemler: Jinekolojik Onkoloji Kliniği'nde 2001-2020 yılları arasında endometrial kanser (EK) tanısı alan hastaların verileri retrospektif olarak değerlendirildi. İleri yaş ve nüks olan 76 olgu değerlendirildi. Merkezimizde histerektomi ameliyatı olan ve takiplerini düzenli olarak sürdüren hastalar çalışmaya dahil edildi.
Bulgular: Nüks anındaki ortalama yaş 74.6 ± 3.9 idi. Hastaların yarısında görülen endometrioid tip en sık görülen histolojik tipti. Hastaların %84,2'sine pelvik paraaortik lenf nodu (LN) örnekleme/diseksiyon uygulandı. Elli altı (%73,7) hastada derin myometrial invazyon, 42 (%56,8) hastada lenfovasküler alan invazyonu (LVSI) saptandı. Ortalama nüks süresi 25,1 ± 17,8 ay bulundu. Toplam sağkalım süreleri 47,2 ± 28,2 ay olarak hesaplandı. Beş yıllık toplam sağkalım (TS) oranı %35,7 olarak analiz edildi. En sık nüks yeri akciğer olup, 14 (%18,5) hastada izole akciğer nüksü görüldü. Pelvik nüks ve ekstra pelvik/çoklu nüks olan hastalar arasında TS açısından anlamlı bir fark yoktu (P= 0.723).
Sonuç: İleri yaş endometriyum kanseri hastalarında nükslerde sağkalım sonuçları daha kötüdür. Bunun nedeni, ek dahili problemler nedeniyle nüks için daha sınırlı tedavi seçenekleri olabilir.

Anahtar Kelimeler

Endometrial kanser, Yaşlı hastalar, Nüks, Lenf bezi

Kaynakça

• 1. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64(1):9-29.
• 2. Ignatov T, Eggemann H, Costa SD, Ortmann O, Ignatov A. Endometrial cancer subtypes are associated with different patterns of recurrence. J Cancer Res Clin Oncol 2018; 144(10):2011-7.
• 3. Makker V, Green AK, Wenham RM, Mutch D, Davidson B, Miller DS. New therapies for advanced, recurrent, and metastatic endometrial cancers. Gynecol Oncol Res Pract 2017; 4:19.
• 4. National Cancer Institute Surveillance, Epidemiology, and End Rsults Program. Cancer stat facts: Uterine cancer 2017.
• 5. Laban M, El-Swaify ST, Ali SH, Refaat MA, Sabbour M, Farrag N, Hassanin AS. The Prediction of Recurrence in Low-Risk Endometrial Cancer: Is It Time for a Paradigm Shift in Adjuvant Therapy? Reprod Sci 2022; 29(4):1068-85.
• 6. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Wárlám-Rodenhuis CC, De Winter KA, Lutgens LC, van den Bergh AC, van der Steen-Banasik E, Beerman H, van Lent M; PORTEC Study Group. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol 2003; 89(2):201-9.
• 7. Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL, Heintz AP, Ngan HY, Pecorelli S. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006; 95 Suppl 1:S105-43.
• 8. Berek JS, Matias-Guiu X, Creutzberg C, Fotopoulou C, Gaffney D, Kehoe S, Lindemann K, Mutch D, Concin N; Endometrial Cancer Staging Subcommittee, FIGO Women's Cancer Committee. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet. 2023; 162(2):383-94.
• 9. Takahashi A, Matsuura M, Matoda M, Nomura H, Okamoto S, Kanao H, Kondo E, Omatsu K, Kato K, Utsugi K, Takeshima N. Clinicopathological Features of Early and Late Recurrence of Endometrial Carcinoma After Surgical Resection. Int J Gynecol Cancer 2017; 27(5):967-72.
• 10. Sohaib SA, Houghton SL, Meroni R, Rockall AG, Blake P, Reznek RH. Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis. Clin Radiol 2007; 62(1):28-34; discussion 35-6.
• 11. Kaewpangchan P, Cheewakriangkrai C. Relapse patterns and outcomes following recurrence of endometrial cancer in northern Thai women. Asian Pac J Cancer Prev 2015; 16(9):3861-6.
• 12. Vargo JA, Kim H, Houser CJ, Berhane H, Sukumvanich P, Olawaiye AB, Kelley JL, Edwards RP, Comerci JT, Huang M, Courtney-Brooks M, Beriwal S. Definitive salvage for vaginal recurrence of endometrial cancer: the impact of modern intensity-modulated-radiotherapy with image-based HDR brachytherapy and the interplay of the PORTEC 1 risk stratification. Radiother Oncol 2014; 113(1):126-31.
• 13. Lin LL, Grigsby PW, Powell MA, Mutch DG. Definitive radiotherapy in the management of isolated vaginal recurrences of endometrial cancer. Int J Radiat Oncol Biol Phys 2005; 63(2):500-4.
• 14. Fung-Kee-Fung M, Dodge J, Elit L, Lukka H, Chambers A, Oliver T; Cancer Care Ontario Program in Evidence-based Care Gynecology Cancer Disease Site Group. Follow-up after primary therapy for endometrial cancer: a systematic review. Gynecol Oncol 2006; 101(3):520-9.
• 15. Kurra V, Krajewski KM, Jagannathan J, Giardino A, Berlin S, Ramaiya N. Typical and atypical metastatic sites of recurrent endometrial carcinoma. Cancer Imaging 2013; 13(1):113-22.
• 16. Iwase H, Furukawa S, Hirasawa T, Asai S, Ohara T, Hosonuma S, Endo S, Tazo Y, Sato H, Takada T, Arai M, Ikeda M, Shida M, Yoshioka N, Tozawa-Ono A, Suzuki N, Mikami M, Onda T. The Clinical Features of Recurrent Endometrial Cancer in Japan: Chemotherapy Instead of Radiotherapy as Postoperative Adjuvant Treatment. Int J Gynecol Cancer 2018; 28(8):1616-23.
• 17. Alemdaroglu S, Durdag GD, Baran SY, Simsek SY, Yetkinel S, Yaginc DA, Guler OC, Celik H. Prognostic factors of endometrial cancer in elderly patient group and their effects on survival. North Clin Istanb 2021; 8(4):345-53.
• 18. Wright JD, Lewin SN, Barrena Medel NI, Sun X, Burke WM, Deutsch I, Herzog TJ. Endometrial cancer in the oldest old: Tumor characteristics, patterns of care, and outcome. Gynecol Oncol 2011; 122(1):69-74.
• 19. Torgeson A, Boothe D, Poppe MM, Suneja G, Gaffney DK. Disparities in care for elderly women with endometrial cancer adversely effects survival. Gynecol Oncol 2017; 147(2):320-8.