Treatment Patterns and Prognosis of Cervical Cancer Patients Aged 65 and Older: A Population-Based Cohort Study

To describe treatment patterns and prognosis in elderly cervical cancer (CC) patients ( ≥ 65 years).

A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results database (2000-2019). Propensity score matching (PSM) balanced baseline characteristics. Overall survival (OS) was assessed using Kaplan-Meier analysis and Cox models. The Cochran-Armitage trend test was used to examine age-related risks of cancer and noncancer-specific death.

Among 45,447 CC patients, 7,026 (15.3%) were elderly. Compared with young ( < 40 years) and middle-aged (40-64 years) patients, elderly patients presented with more local advanced disease (58.1% vs. 34.3% vs. 47.4%), and received less radical surgery treatment (11.2% vs. 26.6% vs. 21%). After PSM, elderly patients had worse survival than younger groups (hazard ratio [HR] = 1.91 vs. young; HR = 1.63 vs. middle-aged; p < 0.0001). Elderly patients who underwent surgery had superior OS across all stages compared with those without surgery (p < 0.0001). In early-stage, radical surgery was superior to radical radiotherapy (p < 0.0001) (5 year OS: 86.6 vs. 69.8%). In resectable LACC, radical surgery and radical radiotherapy were comparable (p > 0.05), whereas in unresectable LACC cases, radical surgery plus radiotherapy provided the highest 5 year OS rate (61.2%) and significantly improved survival (p_{radical surgery + radiotherapy vs. radical surgery}< 0.0001, p_{radical surgery + radiotherapy vs. EBRT + brachytherapy}< 0.0001). Moreover, noncancer deaths increased with age, especially among patients who underwent radical surgery (p < 0.05).

Elderly CC patients present with more advanced stage disease and receive less intensive treatment compared to younger patients. Surgery is feasible, and individualized strategies considering surgical eligibility, postoperative risks, and noncancer mortality are essential to optimize outcomes.