Cancer Chemotherapy and Pharmacology

, Volume 84, Issue 5, pp 1051–1058 | Cite as

Real-world data on initial treatment strategies for older adult patients with endometrial cancer in Japan

  • Mayu YunokawaEmail author
  • Shinsuke Sasada
  • Yae Takehara
  • Kenta Takahashi
  • Tatsunori Shimoi
  • Kan Yonemori
  • Mitsuya Ishikawa
  • Tomoyasu Kato
  • Kenji Tamura
Original Article



Current strategies for the treatment of endometrial cancer in older adult patients require re-evaluation given the global trend in population aging, especially in Japan. We sought to evaluate initial treatment offered to older adult patients with endometrial cancer in Japan.


We retrospectively analyzed data on the standard treatment by age group in patients with endometrial cancer who underwent surgery between January 2005 and December 2013 at the National Cancer Center Hospital (Tokyo, Japan). Patients were stratified into four groups according to age: a younger group, aged 64 years or younger; older adult group 1, aged 65–69 years; older adult group 2, aged 70–74 years; and older adult group 3, aged ≥75 years.


Among 551 patients with endometrial cancer diagnosed and treated at our hospital, data from 531 eligible patients were analyzed. The proportion of patients in the older adult groups 1 or 2 who received standard treatment was the same as in the younger group. However, significantly fewer patients in older adult group 3 received standard treatment compared with the younger group (26% vs. 71%, p = 0.0001). Furthermore, the proportion of patients in older adult group 3 who underwent standard surgery was significantly lower than that in the younger group (26% vs. 72%, p = 0.0001).


The results indicate that age 75 years and older might represent a cutoff for the development of age-based treatment strategies for endometrial cancer. This information could be used to determine the upper age limit for participation in clinical trials in Japan.


Older adult Endometrial cancer Real-world data Standard therapy 



We thank Clare Cox, Ph.D., and Hugh McGonigle from Edanz Group ( for editing a draft of this manuscript.

Author contributions

MY, SS, YT, KT participated in the data collection. MY performed statistical analysis and drafted the manuscript. TS, KY, MI, TK carried out operations or chemotherapy in the study period and helped to draft the manuscript. KT helped to draft the manuscript. All authors read and approved the final manuscript.


No specific funding was received for this study.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest.


  1. 1.
    Saito T, Takahashi F, Katabuchi H, Committee on Gynecologic Oncology of the Japan Society of O, Gynecology (2017) Annual report of the committee on gynecologic oncology, Japan society of obstetrics and gynecology: patient annual report for 2014 and treatment annual report for 2009. J Obstet Gynaecol Res 43(11):1667–1677. CrossRefPubMedGoogle Scholar
  2. 2.
    United States census bureau. International data base. Accessed 31 Dec 2018
  3. 3.
    World Health Organization. Accessed 31 Dec 2018
  4. 4.
    Fleming GF, Brunetto VL, Cella D, Look KY, Reid GC, Munkarah AR, Kline R, Burger RA, Goodman A, Burks RT (2004) Phase III trial of doxorubicin plus cisplatin with or without paclitaxel plus filgrastim in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 22(11):2159–2166. CrossRefPubMedGoogle Scholar
  5. 5.
    Randall ME, Filiaci VL, Muss H, Spirtos NM, Mannel RS, Fowler J, Thigpen JT, Benda JA, Gynecologic Oncology Group S (2006) Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 24(1):36–44. CrossRefPubMedGoogle Scholar
  6. 6.
    Maggi R, Lissoni A, Spina F, Melpignano M, Zola P, Favalli G, Colombo A, Fossati R (2006) Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer 95(3):266–271. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Miller D et al (2012) Late-Breaking Abstract 1: Randomized phase III noninferiority trial of first line chemotherapy for metastatic or recurrent endometrial carcinoma: a Gynecologic Oncology Group study. Gynecol Oncol 125:771–773CrossRefGoogle Scholar
  8. 8.
    Talarico L, Chen G, Pazdur R (2004) Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol 22(22):4626–4631. CrossRefPubMedGoogle Scholar
  9. 9.
    Creasman W (2009) Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 105(2):109. CrossRefPubMedGoogle Scholar
  10. 10.
    Bokhman JV (1983) Two pathogenetic types of endometrial carcinoma. Gynecol Oncol 15(1):10–17CrossRefPubMedGoogle Scholar
  11. 11.
    Wildiers H, Heeren P, Puts M, Topinkova E, Janssen-Heijnen ML, Extermann M, Falandry C, Artz A, Brain E, Colloca G, Flamaing J, Karnakis T, Kenis C, Audisio RA, Mohile S, Repetto L, Van Leeuwen B, Milisen K, Hurria A (2014) International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol 32(24):2595–2603. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, Mor V, Monfardini S, Repetto L, Sorbye L, Topinkova E, Task Force on CGAotISoGO (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol/Hematol 55(3):241–252. CrossRefGoogle Scholar
  13. 13.
    Mathoulin-Pelissier S, Bellera C, Rainfray M, Soubeyran P (2013) Screening methods for geriatric frailty. Lancet Oncol 14(1):e1–e2. CrossRefPubMedGoogle Scholar
  14. 14.
    Decoster L, Van Puyvelde K, Mohile S, Wedding U, Basso U, Colloca G, Rostoft S, Overcash J, Wildiers H, Steer C, Kimmick G, Kanesvaran R, Luciani A, Terret C, Hurria A, Kenis C, Audisio R, Extermann M (2015) Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendationsdagger. Ann Oncol 26(2):288–300. CrossRefPubMedGoogle Scholar
  15. 15.
    Colombo N, Preti E, Landoni F, Carinelli S, Colombo A, Marini C, Sessa C, Group EGW (2013) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi33–vi38. CrossRefPubMedGoogle Scholar
  16. 16.
    Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, Marth C, Nout R, Querleu D, Mirza, Sessa C, Group E-E-EECCW (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Ann Oncol 27(1):16–41. CrossRefPubMedGoogle Scholar
  17. 17.
    Nagase S, Katabuchi H, Hiura M, Sakuragi N, Aoki Y, Kigawa J, Saito T, Hachisuga T, Ito K, Uno T, Katsumata N, Komiyama S, Susumu N, Emoto M, Kobayashi H, Metoki H, Konishi I, Ochiai K, Mikami M, Sugiyama T, Mukai M, Sagae S, Hoshiai H, Aoki D, Ohmichi M, Yoshikawa H, Iwasaka T, Udagawa Y, Yaegashi N, Japan Society of Gynecologic O (2010) Evidence-based guidelines for treatment of uterine body neoplasm in Japan: Japan Society of Gynecologic Oncology (JSGO) 2009 edition. Int J Clin Oncol 15(6):531–542. CrossRefPubMedGoogle Scholar
  18. 18.
    Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Croce C, Mangioni C (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100(23):1707–1716. CrossRefPubMedGoogle Scholar
  19. 19.
    Group As, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373(9658):125–136. CrossRefGoogle Scholar
  20. 20.
    Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375(9721):1165–1172. CrossRefPubMedGoogle Scholar
  21. 21.
    Rauh-Hain JA, Melamed A, Schaps D, Bregar AJ, Spencer R, Schorge JO, Rice LW, Del Carmen MG (2018) Racial and ethnic disparities over time in the treatment and mortality of women with gynecological malignancies. Gynecol Oncol 149(1):4–11. CrossRefPubMedGoogle Scholar
  22. 22.
    Lewin SN, Herzog TJ, Barrena Medel NI, Deutsch I, Burke WM, Sun X, Wright JD (2010) Comparative performance of the 2009 international federation of gynecology and obstetrics’ staging system for uterine corpus cancer. Obstet Gynecol 116(5):1141–1149. CrossRefPubMedGoogle Scholar
  23. 23.
    Ward KK, Shah NR, Saenz CC, McHale MT, Alvarez EA, Plaxe SC (2012) Cardiovascular disease is the leading cause of death among endometrial cancer patients. Gynecol Oncol 126(2):176–179. CrossRefPubMedGoogle Scholar
  24. 24.
    Felix AS, Bower JK, Pfeiffer RM, Raman SV, Cohn DE, Sherman ME (2017) High cardiovascular disease mortality after endometrial cancer diagnosis: results from the Surveillance, Epidemiology, and End Results (SEER) Database. Int J Cancer 140(3):555–564. CrossRefPubMedGoogle Scholar
  25. 25.
    Sud S, Holmes J, Eblan M, Chen R, Jones E (2018) Clinical characteristics associated with racial disparities in endometrial cancer outcomes: a surveillance, epidemiology and end results analysis. Gynecol Oncol 148(2):349–356. CrossRefPubMedGoogle Scholar
  26. 26.
    Tarney CM, Tian C, Wang G, Dubil EA, Bateman NW, Chan JK, Elshaikh MA, Cote ML, Schildkraut JM, Shriver CD, Conrads TP, Hamilton CA, Maxwell GL, Darcy KM (2018) Impact of age at diagnosis on racial disparities in endometrial cancer patients. Gynecol Oncol 149(1):12–21. CrossRefPubMedGoogle Scholar
  27. 27.
    Lee YY, Choi CH, Kim CJ, Song TJ, Kim MK, Kim TJ, Lee JW, Kim BG, Lee JH, Bae DS (2010) Glucose as a prognostic factor in non-diabetic women with locally advanced cervical cancer (IIB-IVA). Gynecol Oncol 116(3):459–463. CrossRefPubMedGoogle Scholar
  28. 28.
    Modh A, Ghanem AI, Burmeister C, Rasool N, Elshaikh MA (2016) Trends in the utilization of adjuvant vaginal brachytherapy in women with early-stage endometrial carcinoma: results of an updated period analysis of SEER data. Brachytherapy 15(5):554–561. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Breast and Medical OncologyNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Medical OncologyThe Cancer Institute Hospital of Japanese Foundation of Cancer ResearchTokyoJapan
  3. 3.Department of Surgical Oncology, Research Institute for Radiation Biology and MedicineHiroshima UniversityHiroshimaJapan
  4. 4.Department of GynecologyNational Cancer Center HospitalTokyoJapan

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