Gynecologic OncologyIncreasing age predicts poor cervical cancer prognosis with subsequent effect on treatment and overall survival
Introduction
In 2017, there is estimated to be almost 13,000 cases of cervical cancer diagnosed, making it the third most common gynecologic malignancy (1). Although cervical cancer screening has helped dramatically in identifying disease at an earlier stage and reducing overall mortality, there is still estimated to be over 4000 women who will die from this disease in the United States this year [1], [2]. As a result, it is imperative that we continue to advance our understanding of both the disease process and of the most effective therapeutic practices.
There are a number of risk factors known to be associated with cervical cancer prognosis, including stage at diagnosis, histology, smoking, and race [1], [3], [4], [5]. Age as an independent prognostic factor for cervical cancer is a question that has been debated and evaluated in the literature without a clear, definitive answer. There is some evidence arguing that older age may serve as an independent factor for poor prognosis [6], [7], [8], whereas other studies have failed to find this association [9], [10]. We aim to evaluate this question using the Surveillance, Epidemiology, and End Results Program (SEER) database and determine the prognostic implication of age at diagnosis in women with cervical cancer. In addition, we aim to determine the impact of age on treatments received, clinical outcomes, and to determine implications for future treatment paradigms.
Section snippets
Patient population
SEER is an online database [11], [12] that aggregates cancer statistic data in the United States based on information from regional cancer registries. Using this resource, we obtained information on the diagnosis, treatment, and outcomes of women diagnosed with cervical cancer between the years of 1973 and 2015 in the United States. This study qualified for institutional review board approval exemption as the SEER data are already deidentified. A SEER program Data-Use agreement was submitted
Demographics
Forty-six thousand three hundred fifty women with cervical cancer were identified. Of these, 54% were aged <50 years, 33% 50–69 years, and 13% ≥70 years. Most patients were white (76%), had a localized stage (50%), and squamous cell histology (70%). Most women received aggressive therapy (75%) (Table 1).
Older women show poorer survival rates, regardless of disease stage
When looking at the total population, overall survival curves for women with cervical cancer tend to separate based on age, with increasingly poorer survival seen as women age (Fig 1a). There
Discussion
Although it is well established that the average age of cervical cancer diagnosis ranges from 35 to 44 years, with a median age of diagnosis of 49 years, there is still a significant number of older women who not only are diagnosed with cervical cancer but also die from it each year (1). From 2009 to 2013, 38% of cervical cancer cases occurred in women 55 years and older, with almost 20% of cases found in women greater than age 65 years [1], [2]. This information is particularly relevant given
Conclusion
As we and others have now shown, advancing age is an independent negative prognostic factor for mortality for women with cervical cancer. It is imperative that we reevaluate our clinical decision-making and not compromise standard of care in the setting of an elderly patient. We acknowledge that each patient is unique and presents with their own set of circumstances that may alter their ability to receive standard of care treatment, but we urge clinicians to strive to achieve this standard in
Acknowledgments
Services and products in support of this research project were generated by the VCU Massey Cancer Center Biostatistics Shared Resource, supported, in part, with funding from NIH–NCI Cancer Center Support Grant P30 CA016059.
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