Beyond the number-Age as a prognostic indicator in endometrial cancer

The integration of molecular classification into endometrial cancer (EC) staging has advanced targeted therapies, yet patient demographics-especially age-remain vital in understanding risk factors, cancer characteristics, and treatment outcomes. As the age of diagnosis decreases, distinguishing the unique needs of patients aged ≤50 versus >50 is crucial for tailored treatment strategies.

A single-institution retrospective study was conducted in the Department of Gynaecological Oncology between January 2015 and June 2021, including 381 surgically treated patients with available electronic medical records, to examine EC distribution, clinical-pathological factors, and survival in women aged ≤50 and >50 years.

Women ≤ 50 years were more likely to have non-aggressive tumours confined to the uterus, with higher ER and PR positivity. In contrast, those >50 years had more aggressive tumours, advanced-stage disease, greater myometrial invasion, LVSI, and a higher incidence of P53 mutations. The older group had a higher proportion of high-risk patients and received more adjuvant therapy (63 % vs. 29 %, p < 0.001), with higher recurrence rates (16 % vs. 9 %). While 3-year OS and DFS were comparable, those > 50 showed a trend toward worse 5-year OS (78 % vs. 98 %, p = 0.09) and DFS (70 % vs. 92 %, p = 0.05).

The study underscores the unique histopathological and molecular features of each age group. Including elderly patients in trials is essential for real-world data, while prognostic markers in younger patients are key to individualised treatment strategies.