Combining the prognostic role of age with molecular advances in the understanding of endometrial cancer

With the rising incidence of endometrial cancer, it is now the most common gynaecological cancer in high-income countries. Globally in 2020, 60 127 patients were diagnosed with endometrial cancer and 341 831 women died due to this disease. 1 Giaquinto AN Broaddus RR Jemal A Siegel RL The changing landscape of gynecologic cancer mortality in the United States. Obstet Gynecol. 2022; 139: 440-442 Crossref PubMed Scopus (42) Google Scholar Particularly troubling is the growing mortality gap disproportionately affecting Black patients with endometrial cancer. New treatment strategies are needed to address both the existing inequalities in mortality among diverse populations and the rising incidence of endometrial cancer globally. In The Lancet Oncology, Famke C Wakkerman and colleagues present results from a combined analysis of data from PORTEC-1, PORTEC-2, and PORTEC-3, identifying a potential causal link between older age and poorer outcomes in endometrial cancer. 2 Wakkerman FC Wu J Putter H et al. Prognostic impact and causality of age on oncological outcomes in women with endometrial cancer: a multimethod analysis of the randomised PORTEC-1, PORTEC-2, and PORTEC-3 trials. Lancet Oncol. 2024; (published online April 30.)https://doi.org/10.1016/S1470-2045(24)00142-6 Google Scholar The data indicate that there is a negative effect on both overall recurrence risk as well as endometrial cancer-specific death with increasing age. The authors identify in this large cohort that older age is associated with a higher frequency of deep myometrial invasion, serous tumour histology, p53-abnormal tumours, and vaginal recurrence. Prognostic impact and causality of age on oncological outcomes in women with endometrial cancer: a multimethod analysis of the randomised PORTEC-1, PORTEC-2, and PORTEC-3 trialsThis study showed that advanced age was associated with more aggressive tumour features in women with endometrial cancer, and was independently and causally related to worse oncological outcomes. Therefore, our findings suggest that older women with endometrial cancer should not be excluded from diagnostic assessments, molecular testing, and adjuvant therapy based on their age alone. Full-Text PDF