Older women with cervical cancer managed surgically have worse outcomes: a National Cancer database study

Abstract

<h3>Objectives:</h3> Women with early stage cervical cancer are typically managed surgically; however, a subset of patients will have risk factors for recurrence (Sedlis and Peters criteria) and will be offered post-operative radiation or chemoradiation to improve outcomes. The purpose of this study is to evaluate if women ≥65 years old with early stage cervical cancer managed surgically are at an increased risk for requiring adjuvant chemoradiation. <h3>Methods:</h3> Data from 2004 to 2016 was abstracted from the National Cancer Database. All women with presumed early stage cervical cancer undergoing radical hysterectomy were included in the study. Adjuvant therapy (radiation or chemoradiation), margin status, regional lymph node involvement, lymphovascular space invasion (LVSI), length-of-stay (LOS), 30-day and 90-day morbidity and mortality, and overall survival were evaluated. Chi-squared, t-test, and Kaplan Meier methods were used for statistical analyses. <h3>Results:</h3> Of the 126,876 women, 16,718 women had a radical hysterectomy and were included in this study. 15,050 (90.0%) were < 65 years old (yo) while 1,668 (10.0%) were ≥65 yo. Women in the ≥65 group were more likely to be Black, have Medicare insurance, and a higher Charlson comorbidity score. Surgical margins and regional lymph nodes were more likely to be positive in women ≥65 yo compared to women < 65 yo (13.3% vs 5.7%; p<0.0001) and (19.3% vs 16.8%; p<0.01). Average tumor size was larger in women ≥65 yo compared to < 65 (3.6 cm vs. 2.5 cm; p<0.0001), and LVSI was more likely to be present (37.8% vs. 31.4%; p<0.001). Women ≥65 yo were more likely to receive adjuvant therapy as opposed to women < 65 yo (40.3% vs 29.3%; p<0.0001). LOS for women ≥65 yo was significantly longer than women < 65 yo (4.3 days vs. 3.4 days; p<0.0001), but 30-day readmission rates did not differ between groups (5.0% vs 6.2%; p=0.12). Women ≥65 yo had a worse prognosis with a mean survival of 51.4 months compared to 58.3 months in women < 65 yo (p<0.0001). Older women also had higher rates of mortality at 30 days (0.8% vs 0.1%; p<0.0001) and 90 days (2.1% vs 0.3%; p<0.0001). <h3>Conclusions:</h3> Women ≥65 yo with early stage cervical cancer were more likely to meet Sedlis and Peters criteria on surgical pathology and receive adjuvant therapy. While hospital readmission rates were similar between age groups, older women had longer LOS with worse overall survival and mortality rates. Women ≥65 years old diagnosed with early stage cervical cancer may benefit from primary chemoradiation.