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Obstetrics & Gynecology 2007;109:655-662
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Prognostic Factors for Uterine Cancer in Reproductive-Aged Women

Nita Karnik Lee, MD1, Michael K. Cheung1, Jacob Y. Shin1, Amreen Husain, MD1, Nelson N. Teng, MD, PhD1, Jonathan S. Berek, MD, MMS1, Daniel S. Kapp, MD, PhD2, Kathryn Osann, PhD3 and John K. Chan, MD1

From the 1 Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, Comprehensive Cancer Center, University of California, San Francisco School of Medicine, San Francisco, California; Division of Gynecologic Oncology, 2 Department of Radiation Oncology, Department of Obstetrics and Gynecology, Stanford Cancer Center, Stanford University School of Medicine, Stanford, California; and the 3 Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, University of California, Irvine – Medical Center, Orange, California.

OBJECTIVE: To determine the prognostic factors that influence the survival of younger women diagnosed with uterine cancer.

METHODS: Demographic and clinico-pathologic data were collected from the National Cancer Institute database between 1988 and 2001. Data were analyzed with Kaplan-Meier methods and Cox proportional hazards regression.

RESULTS: Of the 51,471 women diagnosed with uterine cancer in the study period, 2,076 (4.0%) patients were aged 40 years or younger, and 49,395 (96.0%) were older than 40. The mean age in the younger group was 35.6 years, compared with 65.2 years of the older group. The overall distribution by stage was stage I 75.4%, II 8.1%, III 6.7%, and IV 9.8%. Younger patients were more likely to be nonwhite (42.4% versus 18.3%, P<.001) and have stage I disease (79.2% versus 75.3%, P<.001), grade 1 lesions (47.6% versus 35.6%, P<.001), and sarcomas (15.9% versus 8.2%, P<.001) compared with their older counterparts. The overall 5-year disease-specific survival for younger patients was significantly better than that of older women (93.2% versus 86.4%, P<.001). On multivariable analysis, younger age, earlier stage, lower grade, nonblack race, endometrioid histology, and surgical treatment remained as significant independent prognostic factors for improved survival.

CONCLUSION: This large population-based study demonstrates that patients 40 years and younger have an overall survival advantage compared with women older than 40 years, independent of other clinico-pathologic prognosticators.

LEVEL OF EVIDENCE: III






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