Endometrial Cancer-specific Mortality Research Articles

Analysis of Risk Factors for Secondary Endometrial Cancer-Related Death: A SEER-Based Study.

The aim of this study was to analyze the survival of patients with endometrial cancer diagnosed after a prior cancer and identify risk factors of endometrial cancer death in this population. Totally 1371 women diagnosed with second primary endometrial cancer (SPEC) between 2004 and 2015 were identified using the SEER database. Clinicopathological characteristics were collected, and Fine and Gray regression model was employed to assess the impact of treatment for the first primary cancer (FPC) and SPEC on the mortality of endometrial cancer patients. After propensity score matching (PSM), patients diagnosed with single primary endometrial cancer and SPEC between 2004 and 2015 were included as the second cohort. Kaplan-Meier and Cox survival risk models were used to assess the influence of previous cancer history on survival. Patients previously diagnosed as lung cancer exhibited the lowest overall survival (OS). A diagnostic interval of ≥3 years was significantly associated with higher mortality from SPEC compared with that <3 years. Surgical treatment for SPEC was linked to a reduced risk of endometrial cancer-specific mortality (ECSM) and non-ECSM. Conversely, radiotherapy and chemotherapy were associated with an increased risk of ECSM. The 1-, 3-, and 5-year OS rates of patients with SPEC were significantly lower than those with single primary endometrial cancer whether before or after PSM. Univariate and multivariate analyses further demonstrated that endometrial cancer, either as FPC or SPEC, was independently associated with an increased risk for endometrial cancer-specific survival (ECSS) and OS. Chemotherapy and radiotherapy for SPEC can elevate the risk of ECSM. Whether as FPC or SPEC, endometrial cancer is demonstrated to be a significant independent risk factor for ECSS and OS.

The impact of metformin on survival in diabetic endometrial cancer patients: a retrospective population-based analysis

PurposeThe aim of our study was to assess overall survival and cancer-specific survival in endometrial cancer patients with type 2 diabetes mellitus (T2DM) using metformin.MethodsPatients with endometrial cancer and T2DM during 2000–2012 period were identified from the Lithuanian Cancer Registry and the National Health Insurance Fund database. Cancer-specific and overall survival were primary outcomes.ResultsIn our study we included 6287 women with endometrial cancer out of whom 664 were diagnosed with T2DM (598 metformin users and 66 never users). During follow-up (mean follow-up time was 8.97 years), no differences in risk of endometrial cancer specific mortality was observed in diabetic patients treated with metformin (Hazard Ratio (HR) 0.87, 95% Confidence Interval (CI) 0.70–1.07). Overall mortality in the diabetic metformin ever users’ group was significantly higher compared with the non-diabetic endometrial cancer women (HR 1.17, 95% CI 1.03–1.32) and in the group of metformin never users with T2DM (HR 1.42, 95% CI 1.07–1.87).ConclusionOur study results suggest no beneficial impact on overall and cancer-specific survival in endometrial cancer patients who were treated with metformin as part of their diabetes treatment.

Utilization and Outcomes of Sentinel Lymph Node Biopsy for Early Endometrial Cancer.

To examine trends, characteristics, and oncologic outcomes of sentinel lymph node biopsy for early endometrial cancer. This observational study queried the National Cancer Institute's Surveillance, Epidemiology, and End Results Program by examining 83,139 women with endometrial cancer who underwent primary hysterectomy with nodal evaluation for T1 disease from 2003 to 2018. Primary outcome measures were the temporal trends in utilization of sentinel lymph node biopsy and patient characteristics associated with sentinel lymph node biopsy use, assessed by multivariable binary logistic regression models. Secondary outcome measure was endometrial cancer-specific mortality associated with sentinel lymph node biopsy, assessed by propensity score inverse probability of treatment weighting. The utilization of sentinel lymph node biopsy increased from 0.2 to 29.7% from 2005 to 2018 (P<.001). The uptake was higher for women with endometrioid (0.3-31.6% between 2005 and 2018) compared with nonendometrioid (0.6-21.0% between 2006 and 2018) histologic subtypes (both P<.001). In a multivariable analysis, more recent year surgery, endometrioid histology, well-differentiated tumors, T1a disease, and smaller tumor size were independently associated with sentinel lymph node biopsy use (P<.05). Performance of sentinel lymph node biopsy was not associated with increased endometrial cancer-specific mortality compared with lymphadenectomy for endometrioid tumors (subdistribution hazard ratio [HR] 0.96, 95% CI 0.82-1.13) or nonendometrioid tumors (subdistribution HR 0.85, 95% CI 0.69-1.04). For low-risk endometrial cancer, the increase in sentinel lymph node biopsy resulted in a 15.3 percentage-point (1.4-fold) increase in surgical nodal evaluation by 2018 (expected vs observed rates, 37.8 vs 53.1%). The landscape of surgical nodal evaluation is shifting from lymphadenectomy to sentinel lymph node biopsy for early endometrial cancer in the United States, with no indication of a negative effect on cancer-specific survival.

Obesity and mortality among endometrial cancer survivors: A systematic review and meta-analysis.

Excess body fat is a major risk factor for endometrial cancer incidence, but its impact on recurrence and survival remains unclear. The aim of this systematic review and meta-analysis was to assess the association between excess body fat with recurrence, cancer-specific, and all-cause mortality among endometrial cancer survivors. We searched MEDLINE and EMBASE databases up to July 2021. Risk of bias was assessed with the Ottawa Newcastle Scale. Random effects models estimated pooled hazard ratios for the main associations between body mass index (BMI) and survival outcomes and stratified by endometrial cancer type. Potential heterogeneity and publication bias were evaluated with sensitivity analyses, funnel plots, and Egger's test. Forty-six studies were included, of which 45 estimated body fat with BMI and six used direct waist circumference measures or CT/MRI scans. Higher BMI (≥30 kg/m2 ) was associated with increased all-cause mortality (HR = 1.34, 95%CI = 1.12-1.59) and recurrence (HR = 1.28, 95%CI = 1.06-1.56). In sub-group analysis, associations between higher BMI and all-cause mortality were observed for both Types I and II survivors, while recurrence associations were only significant among Type I cases. Obesity at endometrial cancer diagnosis was associated with increased cancer recurrence and all-cause mortality among endometrial cancer survivors but not endometrial cancer-specific mortality.

Competing risk nomogram predicting cancer-specific mortality for endometrial cancer patients treated with hysterectomy.

BackgroundThe incidence of endometrial cancer has tended to increase in recent years. However, competing risk nomogram combining comprehensive factors for endometrial cancer patients treated with hysterectomy is still scarce. Therefore, we aimed to build a competing risk nomogram predicting cancer‐specific mortality for endometrial cancer patients treated with hysterectomy.MethodsPatients diagnosed with endometrial cancer between 2010 and 2012 were abstracted from the Surveillance, Epidemiology, and End Results (SEER) database. Competing risk model was performed to select prognostic variables to build the competing risk nomogram to predict the cumulative 3‐ and 5‐year incidences of endometrial cancer‐specific mortality. Harrell's C‐index, receiver operating characteristic (ROC) curve, and calibration plot were used in the internal validation. And decision curve analysis was applied to evaluate clinical utility.ResultsA total of 10,447 patients were selected for analysis. The competing risk nomogram identified eight prognostic variables, including age at diagnosis, race, marital status at diagnosis, grade, histology, tumor size, FIGO stage, and number of regional nodes positive. The C‐index of the competing risk nomogram was 0.857 (95% confidence interval [CI]: 0.854–0.859), and the calibration plots were adequately fitted. When the threshold probabilities were between 1% and 57% for 3‐year prediction and between 2% and 67% for 5‐year prediction, the competing risk nomogram was of good clinical utility.ConclusionsA competing risk nomogram for endometrial cancer patients treated with hysterectomy was successfully built and internally validated. It was an accurately predicted and clinical useful tool, which could play an important role in consulting and health care management of endometrial cancer patients.

Is there sufficient evidence to recommend women diagnosed with endometrial cancer take a statin: Results from an Australian record-linkage study

ObjectiveA recent paper suggested all women with endometrial cancer should take statins but it is unclear whether there is sufficient evidence to justify this recommendation. MethodsWe identified all women diagnosed with uterine cancer in Australia between July 2003 and December 2013 (2012 in New South Wales) through the Australian Cancer Database (N = 16,501) and linked these to the national prescription database and National Death Index to identify statin use and survival outcomes to December 2015. We used Cox proportional hazards regression to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the associations between statin use and survival. ResultsAmong the 15,703 women with endometrial cancer, pre-diagnosis statin use was not associated with survival. Endometrial cancer-specific mortality was lower among women who used statins after diagnosis (time-varying models: HR = 0.92; 95%CI 0.82–1.03) but the association was only seen among women with type 1 cancers (0.87; 0.76–1.00), for hydrophilic statins (0.84; 0.68–1.03) and for new use of statins after diagnosis (0.75; 0.59–0.95). There was a weak dose-response with increasing number of statin prescriptions. Sensitivity analyses using inverse probability of treatment weights were similar. ConclusionWomen with endometrial cancer who take statins after diagnosis may have better survival than those who do not use statins. However, it is impossible to completely rule out bias, particularly reverse causation where disease status may affect statin use. We believe it is too early to recommend all women with endometrial cancer take statins, but there is sufficient evidence to justify a randomized trial.

A population-based study of causes of death after endometrial cancer according to major risk factors

ObjectiveTo identify the most common causes of death and potentially modifiable risk factors in endometrial cancer patients. Methods745 women diagnosed with incident endometrial cancer were enrolled in a population-based study from 1991 to 1994. Participants completed structured interviews about 1 year after diagnosis. Study files were linked with the National Death Index to identify dates and causes of death through 2016. Proportional hazards regression was used to estimate hazard rate ratios for cause of death adjusting for age and stage of disease. Hazard ratios were also examined according to comorbidities. ResultsOf the 745 women, 450 were deceased after a median of 19.9 years. The two most common causes of death were cardiovascular disease (N = 145, 32%) and any cancer (N = 135, 30%), with only 10% of women dying from endometrial cancer (N = 46). Obesity, diabetes and smoking increased risk of all-cause mortality (HRR 1.77, 95%CI 1.36–2.31; HRR 1.74, 95%CI 1.34–2.27; HRR 1.59, 95%CI 1.16–2.17). Diabetes also increased risk of cardiovascular disease-specific mortality (HRR 1.98, 95%CI 1.38–3.08), but not endometrial cancer mortality (HRR 0.55, 95%CI 0.21–1.48). Neither obesity nor smoking was associated with increased risk of cardiovascular disease-specific mortality (HRR 1.46, 95%CI 0.92–2.32; HRR 1.21, 95%CI 0.67–2.18) nor endometrial-cancer specific mortality (HRR 1.81, 95%CI 0.83–3.93; HRR 0.61, 95%CI 0.17–2.15). ConclusionsEndometrial cancer patients were 3 times more likely to die of cardiovascular disease than endometrial cancer. Obesity, smoking and diabetes increase the risk of death in these patients and are potentially modifiable. Clinical trials should be developed that incorporate counseling regarding these risk factors into survivorship care to determine impact on mortality.

Prognostic factors for rural endometrial cancer patients in a population-based cohort

BackgroundEndometrial cancer is the second most common cancer among female cancer survivors in the US and is increasing in incidence. Rural endometrial cancer patients experience lower survival rates but the reasons for the lower survival are not known. The aim of this study is to examine whether prognostic factors are different for rural and urban patients in a population-based cohort.MethodsEndometrial cancer patients diagnosed 1997-2012 were identified through the Utah Cancer Registry and Utah Population Database. The address at cancer diagnosis was used to classify patients in rural or urban residences. Demographic and cancer-specific characteristics were examined as prognostic factors for both all-cause and endometrial cancer-specific mortality using Cox proportional hazards models.ResultsThere were 2,994 endometrial cancer patients and 14.1% of these patients lived in rural areas at diagnosis. Rural endometrial cancer patients were older at cancer diagnosis and did not appear to be different in terms of obesity or overweight at cancer diagnosis. There were no differences for treatment or stage at diagnosis although rural patients had higher proportions of higher grade. Age at diagnosis, poverty, education, and histology were significant prognostic factors for all-cause death. Rural patients with more advanced stages of cancer had significantly increased risks of all-cause and endometrial cancer-specific death than urban patients. Rural endometrial cancer patients diagnosed at advanced stage had a 17-fold increase in the risk of all-cause death compared to an 8-fold increase in death for urban patients.ConclusionsRural endometrial cancer patients in Utah were older at diagnosis, had higher grade and higher comorbidities. While urban and rural endometrial cancer patients shared many prognostic factors, the risk of mortality is greater among rural patients with advanced stage endometrial cancer. Future studies should examine where patients are receiving treatment and how that impacts their survival and how to reduce the mortality rates of high risk patients.

Adiponectin, Leptin, and Insulin-Pathway Receptors as Endometrial Cancer Subtyping Markers

Developing a system of molecular subtyping for endometrial tumors might improve insight into disease etiology and clinical prediction of patient outcomes. High body mass index (BMI) has been implicated in development of endometrial cancer through hormonal pathways and might influence tumor expression of biomarkers involved in BMI-sensitive pathways. We evaluated whether endometrial tumor expression of 7 markers from BMI-sensitive pathways of insulin resistance could effectively characterize molecular subtypes: adiponectin receptor 1, adiponectin receptor 2, leptin receptor, insulin receptor (beta subunit), insulin receptor substrate 1, insulin-like growth factor 1 receptor, and insulin-like growth factor 2 receptor. Using endometrial carcinoma tissue specimens from a case-only prospective sample of 360 women from the Nurses' Health Study, we scored categorical immunohistochemical measurements of protein expression for each marker. Logistic regression was used to estimate associations between endometrial cancer risk factors, especially BMI, and tumor marker expression. Proportional hazard modeling was performed to estimate associations between marker expression and time to all-cause mortality as well as time to endometrial cancer-specific mortality. No association was observed between BMI and tumor expression of any marker. No marker was associated with time to either all-cause mortality or endometrial cancer-specific mortality in models with or without standard clinical predictors of patient mortality (tumor stage, grade, and histologic type). It did not appear that any of the markers evaluated here could be used effectively to define molecular subtypes of endometrial cancer.

Endometrial Cancer Risk Factors, Hormone Receptors, and Mortality Prediction.

Background: Endometrial tumors arise from a hormonally responsive tissue. Defining subtypes by hormone receptor expression might better inform etiology and prediction of patient outcomes. We evaluated the potential role of tumor estrogen receptor (ER) and progesterone receptor (PR) expression to define endometrial cancer subtypes.Methods: We measured semi-continuous ER and PR protein expression in tissue specimens from 360 endometrial primary tumors from the Nurses' Health Study. To explore the impact of different definitions of marker positivity, we dichotomized ER and PR expression at different cut points in increments of 5% positive cells. Logistic regression was used to estimate associations between endometrial cancer risk factors, such as body mass index, with dichotomous ER or PR status. Reclassification statistics were used to assess whether adding dichotomous ER or PR status to standard prognostic factors of stage, grade, and histologic type would improve endometrial cancer-specific mortality prediction.Results: Compared with not being obese, obesity increased the odds of having an ER-positive tumor at cut points of 0% to 20% [maximum OR, 2.92; 95% confidence interval (CI), 1.34-6.33] as well as the odds of having a PR-positive tumor at cut points of 70% to 90% (maximum OR, 2.53; 95% CI, 1.36-4.68). Adding dichotomous tumor ER or PR status to the panel of standard predictors did not improve both model discrimination and calibration.Conclusions: Obesity may be associated with greater endometrial tumor expression of ER and PR. Adding either marker does not appear to improve mortality prediction beyond the standard predictors.Impact: Body mass index might explain some of the biological variation among endometrial tumors. Cancer Epidemiol Biomarkers Prev; 26(5); 727-35. ©2017 AACR.

High cardiovascular disease mortality after endometrial cancer diagnosis: Results from the Surveillance, Epidemiology, and End Results (SEER) Database.

Obesity is a strong risk factor for developing endometrial cancer and cardiovascular disease (CVD); consequently, understanding CVD mortality among endometrial cancer survivors is important. We analyzed Surveillance, Epidemiology and End Results Program data for 157,496 endometrial cancer cases diagnosed between 1988 and 2012. We calculated standardized mortality ratios (SMRs) for CVD and all-cause mortality comparing endometrial cancer cases and general population women. We categorized women into one of three prognostic groups (excellent, intermediate and poor) based on tumor characteristics. Cumulative incidence function curves were plotted to visualize absolute mortality risk in the presence of competing risks. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression for cause-specific mortality. Deaths were as follows: endometrial cancer 40.6%, CVD 20.5%, other cancers 18.7% and other causes 20.3%. Women with endometrial cancer were more likely to die from CVD (age-adjusted SMR = 8.8, 95% CI = 8.7-9.0) and all causes (age-adjusted SMR = 15.9, 95% CI = 15.8-16.0) compared to general population women. In case-only analyses, higher CVD mortality was associated with older age, Black ethnicity and lack of surgical treatment. Poor prognosis cancers (non-endometrioid histology and late stage) were related to higher mortality from each cause, with the highest HRs observed for endometrial cancer-specific mortality. Among women diagnosed with excellent prognosis tumors (endometrioid, well-differentiated and early stage), absolute risk of CVD mortality surpassed endometrial cancer-specific mortality 5 years after diagnosis. Women diagnosed with common forms of endometrial cancer have a high CVD burden. After diagnosis, cardiovascular health should be emphasized for these women to reduce mortality.

Obesity and Endometrial Cancer.

Endometrial cancer is the sixth most common cancer in women worldwide and the most common gynecologic malignancy in the developed world. This chapter explores the current epidemiologic evidence on the association between obesity and endometrial cancer risk and mortality. Using body mass index (BMI) as a measure of obesity, we found that obesity (defined as BMI >30 and <35kg/m2) was associated with a 2.6-fold increase in endometrial cancer risk, while severe obesity (BMI>35kg/m2) was associated with a 4.7-fold increase compared to normal-weight women (BMI<25kg/m2). Increased central adiposity also increased endometrial cancer risk by 1.5- to twofold. Among both healthy and endometrial cancer patient populations, obesity was associated with a roughly twofold increase in endometrial cancer-specific mortality. This risk reduction was also observed for obesity and all-cause mortality among endometrial cancer patients. In the few studies that assessed risk associated with weight change, an increased endometrial cancer risk with weight gain and weight cycling was observed, whereas some evidence for a protective effect of weight loss was found. Furthermore, early-life obesity was associated with a moderately increased risk of endometrial cancer later in life. There are several mechanisms whereby obesity is hypothesized to increase endometrial cancer risk, including increased endogenous sex steroid hormones, insulin resistance, chronic inflammation and adipokines. Further research should focus on histological subtypes or molecular phenotypes of endometrial tumors and population subgroups that could be at an increased risk of obesity-associated endometrial cancer. Additionally, studies on weight gain, loss or cycling and weight loss interventions can provide mechanistic insight into the obesity-endometrial cancer association. Sufficient evidence exists to recommend avoiding obesity to reduce endometrial cancer risk.

Menopausal hormone therapy and mortality among endometrial cancer patients in the NIH-AARP Diet and Health Study.

While menopausal hormone therapy (MHT) is an established endometrial cancer risk factor, its relationship with mortality among endometrial cancer patients is understudied. Within the NIH-AARP Diet and Health Study, we examined the associations of pre-diagnosis MHT use with 10-year all-cause and endometrial cancer-specific mortality among 890 endometrial cancer patients. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for tumor characteristics, treatment, and other risk factors. Endometrial cancer cases were diagnosed a median of 4.6years (range 0.0-10.1years) after the second risk factor questionnaire was completed. We identified a total of 241 deaths, of which 104 were due to endometrial cancer. Compared with non-MHT use, pre-diagnosis use of estrogen plus progestin therapy (EPT)-only was associated with lower 10-year all-cause (HR 0.65, 95% CI 0.43-0.99, based on 29 deaths) and endometrial cancer-specific mortality (HR 0.51, 95% CI 0.26-0.98, based on 11 deaths). Recency of MHT use, assessed approximately 5years prior to the endometrial cancer diagnosis, was associated with mortality. Compared with non-MHT users, former ET users had higher all-cause (HR 1.71, 95% CI 1.02-2.88, based on 18 deaths) and endometrial cancer-specific mortality (HR 2.17, 95% CI 0.96-4.90, based on 8 deaths), whereas current EPT users had nonsignificant lower risks of death. Based on small numbers, we observed that pre-diagnosis use of EPT was related to lower mortality among endometrial cancer patients. Future studies examining the biological mechanisms underlying this association are warranted.

Prediagnosis Body Mass Index, Physical Activity, and Mortality in Endometrial Cancer Patients

Background Higher body mass index (BMI) and inactivity have been associated with a higher risk of developing endometrial cancer, but the impact on endometrial cancer survival is unclear. Methods Among incident endometrial cancer case subjects in the National Institutes of Health-AARP Diet and Health Study, we examined associations of prediagnosis BMI (n = 1400) and physical activity (n = 875) with overall and disease-specific 5- and 10-year mortality. Using Cox proportional hazards regression, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for tumor characteristics, treatment, and other risk factors. All statistical tests were two-sided. Results Compared with women with a BMI in the range of 18.5 to less than 25kg/m(2), the hazard ratios for 5-year all-cause mortality were 1.74 (95% CI = 1.13 to 2.66) for BMI in the range of 25 to less than 30kg/m(2), 1.84 (95% CI = 1.17 to 2.88) for BMI in the range of 30 to less than 35kg/m(2), and 2.35 (95% CI = 1.48 to 3.73) for BMI greater than or equal to 35kg/m(2) (P trend < .001). Higher BMI was also statistically significantly associated with poorer endometrial cancer-specific but not cardiovascular disease 5-year mortality. Hazard ratio estimates for 10-year all-cause and endometrial cancer-specific mortality as related to BMI were similar to 5-year hazard ratio estimates, whereas 10-year cardiovascular disease mortality became statistically significant (HR = 4.08; 95% CI = 1.56 to 10.71 comparing extreme BMI groups). More physical activity was related to lower all-cause 5-year mortality (HR = 0.57, 95% CI = 0.33 to 0.98 for >7 hours/week vs never/rarely), but the association was attenuated after adjustment for BMI (HR = 0.64, 95% CI = 0.37 to 1.12). No association was observed between physical activity and disease-specific mortality. Conclusions Our findings suggest that higher prediagnosis BMI increases risk of overall and disease-specific mortality among women diagnosed with endometrial cancer, whereas physical activity lowers risk. Intervention studies of the effect of these modifiable lifestyle factors on mortality are needed.

Body mass index, physical activity, and survival after endometrial cancer diagnosis: Results from the Women's Health Initiative

ObjectiveWhile low physical activity and high body mass index (BMI) have been associated with higher endometrial cancer incidence, no previous studies have evaluated the association between physical activity and survival after endometrial cancer diagnosis, and studies on BMI and survival have not been performed in a prospective cohort. MethodsWe examined pre-diagnosis BMI and moderate- to vigorous-intensity physical activity in relation to overall and disease-specific survival among 983 postmenopausal women who were diagnosed with endometrial cancer in the Women's Health Initiative Observational Study and Clinical Trials. ResultsOver a median 5.2 (max 14.1) years from diagnosis to death or end of follow-up, 163 total deaths were observed, 66 of which were due to endometrial cancer. We observed a higher all-cause mortality hazard ratio (HR)=1.85 (95% CI 1.19–2.88) comparing women with a BMI≥35kg/m2 to women with BMI<25kg/m2. For endometrial cancer-specific mortality the HR=2.23 (95% CI 1.09–4.54) comparing extreme BMI categories. To examine histologic subtypes we analyzed type I endometrial tumors separately and found an HR=1.20 (95% CI 1.07–1.35) associated with all-cause mortality for each 5-unit change in BMI. Moderate- to vigorous-intensity physical activity was not associated with all-cause or endometrial cancer-specific mortality. ConclusionsPre-diagnosis BMI, but not physical activity, was associated with survival among women with endometrial cancer. Future studies should investigate mechanisms and timing of BMI onset to better understand the burden of disease attributable to BMI.

The impact of surgery on survival of elderly women with endometrial cancer in the SEER program from 1992–2002

Objectives Few population-based studies have evaluated surgical treatment and outcomes in elderly patients with endometrial cancer. The National Cancer Institute's SEER, Surveillance, Epidemiology and End Results, Program provides a database to examine this issue. The objective of this study was to determine the extent to which elderly women with endometrial cancer receive surgical treatment and to evaluate the impact of surgery on survival. Methods Data were obtained from the SEER registries for expanded races from 1992–2002. The inclusion criteria were women ages 50 to 95 with pathologically confirmed endometrial cancer. Cases with multiple primaries were excluded. The data were examined with respect to histology, radiotherapy use, extent of surgery and FIGO stage. The survival data were analyzed using a Cox proportional hazard model. Chi-squared tests were used to examine the extent to which elderly women with endometrial cancer receive surgical treatment, hysterectomy at minimum. Endometrial cancer-specific mortality was analyzed. Results 27,517 women were analyzed with 94% of the cohort receiving surgical treatments. There is a significant trend that suggests elderly women, aged 65+ years at time of endometrial cancer diagnosis, received surgical treatment less often than younger women ( p < 0.001). The age-adjusted hazard of death was reduced with surgical intervention. After adjustment for stage at diagnosis, histology, and radiotherapy, the hazard ratios for endometrial cancer-specific mortality were decreased when surgery was undertaken. Conclusions In this population-based study, the poor prognosis associated with advanced age may be in part associated with the decreased frequency of surgical treatment. The reasons need to be further investigated. Continued efforts should be directed at providing surgical treatment for elderly patients with endometrial cancer.