The usefulness of geriatric assessment of older patients with Endometrial Cancer: our institutional study

The usefulness of geriatric assessment of older patients with Endometrial Cancer: our institutional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The usefulness of geriatric assessment of older patients with Endometrial Cancer: our institutional study SHOTA HORIKAWA, Keiko Yamanouchi, Shiori Sano, Risako Yamaguchi, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8208421/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Older patients with cancer are at an increased risk of treatment-related complications and poor survival. However, evidence of the usefulness of geriatric assessment (GA) in gynecological oncology remains limited. We aimed to investigate the relationship between GA and treatment-related complications and prognosis in older patients with endometrial cancer at our institution. Methods We retrospectively analyzed 41 patients aged ≥ 65 years with endometrial cancer who underwent surgery at our institution between July 2020 and April 2024. Preoperative GA included the G8 score, Instrumental Activities of Daily Living, Charlson Comorbidity Index, residential status, and Mini-Cog test. We also evaluated preoperative anemia, undernutrition, postoperative complications, delirium, and survival outcomes. Results Abnormal G8 scores and cognitive decline were observed in 39% and 15% of patients, respectively. Postoperative complications occurred more frequently in patients with cognitive impairment than in those without (p = 0.027). Progression-free survival was significantly shorter in patients with abnormal G8 scores (p = 0.029), cognitive impairment (p = 0.015), and anemia (p = 0.015) than in those without. Overall survival was significantly shorter in patients with anemia (p = 0.016) and undernutrition (p = 0.043) than in those without. Conclusion GA was significantly associated with postoperative complications and survival outcomes in older patients with endometrial cancer. Abnormal G8 scores, cognitive impairment, preoperative anemia, and undernutrition are useful prognostic factors. Incorporating GA into routine preoperative evaluations could help to identify high-risk patients and guide personalized treatment strategies in gynecological oncology. geriatric assessment endometrial cancer G8 score cognitive decline anemia undernutrition Figures Figure 1 Figure 2 Introduction In Japan, the proportion of older individuals has markedly increased owing to the declining birth rate and improvements in life expectancy. While older individuals (≥ 65 years) accounted for < 5% of the population in 1950, this rate increased to 29.1% in 2023 and is projected to reach 38.7% by 2070, one of the highest aging rates worldwide [ 1 ]. In parallel, cancer-related deaths among older individuals increased from 80.4% in 2010 to 88.4% in 2023, and this proportion is expected to continue to increase [ 2 ]. Older patients with cancer often present with organ dysfunction, comorbidities, and geriatric syndromes, which increase the risk of treatment-related adverse events and impair their quality of life. They are highly susceptible to surgical complications, such as ureteral or intestinal injuries, and age-specific conditions, including dementia, delirium, and functional decline, which may interfere with treatment. A previous study has shown that postoperative delirium was significantly more frequent in patients with endometrial cancer (EC) who were aged ≥ 70 years than in younger patients (14% vs. 1.6%) [ 3 ]. Given these vulnerabilities, older patients with cancer are frequently excluded from clinical trials, underscoring the urgent need for evidence-based research tailored to this population. Geriatric assessment (GA) is a multidimensional tool that evaluates comorbidities, nutrition, cognition, functional status, and geriatric syndromes, enabling the identification of patients at high risk of adverse outcomes and guiding management decisions [ 4 ]. Among GA instruments, the G8 screening tool has been associated with postoperative complications in patients with hepatocellular carcinoma aged ≥ 70 years [ 5 ] and with short overall survival (OS) across older populations with cancer [ 6 ]. However, evidence specifically addressing the role of GA in gynecological cancers remains limited. Therefore, we aimed to investigate the relationship between GA and treatment-related complications and prognosis in older patients with EC at our institution. Patients and Methods Patients We retrospectively analyzed patients aged ≥ 65 years with EC who underwent surgery at the Yamagata University Hospital between July 2020 and April 2024. Geriatric assessment Preoperative geriatric assessment (GA) was performed and included the following domains: G8 screening tool (17-point score; <14 defined as abnormal), Instrumental Activities of Daily Living (IADL; 8-point female version; <7 defined as impaired), Charlson Comorbidity Index (CCI; ≥3 defined as comorbidity), residential status (living alone or not), and Mini-Cog test (three-word recall and clock-drawing test; impaired if criteria were met). Clinical factors The following variables were also evaluated: age at diagnosis, disease stage, preoperative anemia (hemoglobin < 11.6 g/dL), preoperative undernutrition (albumin < 4.0 g/dL), postoperative complications, postoperative delirium, and survival outcomes (progression-free survival [PFS] and OS). Postoperative complications were defined as grade ≥ 2 according to the Clavien–Dindo classification (Table 1). Surgical restriction was defined as the omission of lymph node dissection based on the institutional criteria (Table 2). Statistical analysis Comparisons between groups were performed using Fisher’s exact test, chi-square test, and log-rank test. Analyses were conducted using the EZR software. p-value < 0.05 was considered statistically significant. Ethics statement This study was approved by the Ethics Committee of Yamagata University Faculty of Medicine (approval no.: 2022 − 197). The requirement for informed consent was waived because of the retrospective study design. Results Patient characteristics We analyzed 41 patients with EC aged ≥ 65 years who underwent surgery. The median age at diagnosis was 68 years (range, 65–86), and 13 patients (32%) were aged ≥ 75 years. The median body mass index was 26.8 kg/m² (range, 20.4–33.3), and 18 patients (44%) had body mass index ≥ 25 kg/m². The median follow-up period for the entire cohort was 769 days (range, 43–1647). Early stage disease was predominant; 29 patients (70%) had Stage II or lower disease, with Stage IA/IB comprising the majority. Based on the institutional criteria, 16 patients (39%) underwent surgical restriction (omission of lymph node dissection). The baseline characteristics of the patients are summarized in Table 3. GA domains and preoperative factors Preoperative GA identified the following: abnormal G8 scores in 16 patients (39%), impaired IADL in 6 (15%), CCI ≥ 3 in 8 (19%), living alone in 6 (15%), and cognitive impairment on Mini-Cog in 6 (15%). Preoperative anemia (hemoglobin < 11.6 g/dL) was present in 4 patients (10%), and undernutrition (albumin < 4.0 g/dL) was present in 9 patients (22%). One patient had missing data on IADL, residential status, and Mini-Cog (percentages calculated from non-missing data). Postoperative complications and delirium Postoperative complications occurred in 23 patients (56%). Complications were significantly more frequent among patients with cognitive impairment than among those without (p = 0.027), whereas no significant associations were observed for other GA domains (Table 4). Complication rates did not differ significantly according to the surgical restriction status (48% vs. 28%, p = 0.22). Constipation/bowel obstruction was the most common event; 19 patients (46%) required laxatives. Postoperative delirium occurred in 4 patients (10%) and was not associated with GA domains or surgical restriction. Recurrence and survival Thirteen patients (32%) experienced recurrence, with a higher incidence in the dementia group than in the group without dementia (31% vs. 7%, p = 0.055). Eleven deaths (27%) occurred: 10 due to EC progression and one due to concomitant cholangiocarcinoma. Stage III or IV disease was associated with a high recurrence rate (54% vs. 18%, p = 0.029) and a high mortality rate (55% vs. 20%, p = 0.052). The event proportions did not differ significantly between patients with and without surgical restrictions (recurrence: 54% vs. 32%, p = 0.33; death: 64% vs. 30%, p = 0.074) (Table 5). Time-to-event outcomes PFS was significantly shorter in patients with abnormal G8 scores, cognitive impairment, and anemia than in those without (G8: median 613 days [211–NR] vs. NR [589–NR], p = 0.029; dementia: 288 days [42–NR] vs. NR, p = 0.015; anemia: 241 days [153–NR] vs. NR, p = 0.015). OS showed a non-significant shortening trend in the abnormal G8 score group (NR [589–NR] vs. NR, p = 0.196). In contrast, OS was significantly shorter in patients with anemia and undernutrition than in those without (anemia: 610 days [325–NR] vs. NR, p = 0.016; undernutrition: 589 days [325–NR] vs. NR, p = 0.043) (Fig. 1 ). Surgical restriction subgroup PFS tended to be shorter in the surgical restriction group than in the group without surgical restriction; however, the difference was not statistically significant (646 days [302–NR] vs. NR, p = 0.21). In contrast, OS was significantly shorter in the surgical restriction group than in the group without surgical restriction (1189 days [477–NR] vs. NR, p = 0.016) (Fig. 2 ). The background factors did not differ significantly between the groups with and without surgical restriction (Table 6). Discussion In this institutional study, we investigated the association between GA and postoperative complications and prognosis in older patients with EC. Abnormal G8 scores, cognitive decline, preoperative anemia, and undernutrition were significantly associated with poor outcomes. Cognitive decline was associated with postoperative complications. GA has been widely proposed as an inclusive framework for capturing the heterogeneity of cancer in older adults, and its clinical utility has been reported across various tumor types. Several studies have shown that GA is associated with the prognosis of patients with cancer. Kenis et al. reported that G8 abnormalities significantly shortened OS in patients aged ≥ 70 years across all cancer types and that G8 screening may serve as a predictor of prognosis not only for patients undergoing surgery but also for patients undergoing chemotherapy and radiotherapy [ 6 ]. In addition to these mixed cancer cohorts and hepatocellular carcinoma, where Kaibori et al. showed that abnormal G8 scores predicted postoperative complications [ 5 ], gynecological oncology-specific data are emerging. Michaan et al. demonstrated that comprehensive GA correlated with OS in gynecological malignancies [ 7 ], whereas Puviani et al. reported that preoperative G8 abnormalities predicted postoperative complications in patients with gynecological cancer [ 8 ]. Consistent with these findings, in our EC-only cohort, we observed that GA vulnerabilities were linked to adverse outcomes: abnormal G8 scores were associated with short PFS, and cognitive impairment was associated with postoperative complications. Unlike previous studies that have shown significant associations between GA and OS, we did not observe such an association in our study cohort. This discrepancy may be explained by disease site restriction to EC, relatively small sample size, predominance of earlier stages, short follow-up duration, reliance on G8 screening rather than full GA, and potential institutional selection criteria for surgical indications. Taken together, our findings are directionally consistent with the gynecological oncology literature while adding site-specific evidence for EC and highlighting GA domains (G8, cognition, anemia, and undernutrition) that may be the most informative for perioperative risk stratification and prognosis. In our study, the dementia group experienced postoperative complications, most of which included constipation or bowel obstruction. Although no patient experienced complications above grade III according to the Clavien–Dindo classification, and most cases were grade II or below, these events still affected postoperative recovery. Cognitive decline may contribute to such complications through several mechanisms, including decreased physical activity and mobility after surgery, reduced self-management and responsiveness to bowel symptoms, and inadequate oral intake (including insufficient hydration). In addition, polypharmacy and constipation medications are common in patients with cognitive impairment, which may further predispose them to postoperative bowel dysfunction. These combined factors likely explain why constipation and bowel obstruction were more frequently observed in patients with cognitive impairment than in those without. In addition to postoperative morbidity, dementia has been associated with poor long-term survival. Raji et al. reported that preexisting dementia is associated with increased mortality in breast, colon, and prostate cancers, often due to non-cancer causes [ 9 ]. Dementia may worsen prognosis through complications such as aspiration and delirium, difficulty in obtaining informed consent, and reduced recognition of subjective symptoms [ 10 ]. In our study, patients in the dementia group tended to be older and had advanced disease at diagnosis, which may partly explain their poor prognoses. These findings suggest that delayed presentation due to a lack of symptom recognition could be a contributory factor. In addition, a previous report showed that OS was associated with the Geriatric Vulnerability Score, which included albuminemia < 35 g/L, Activities of Daily Living score < 6, IADL score < 25, lymphopenia 14, in patients with advanced (Stages III–IV) ovarian cancer aged > 70 years [ 11 ]. Moreover, OS was associated with cognitive function in patients with gynecological cancer [ 7 ]. Our findings further highlight that anemia and malnutrition are not only markers of frailty but may also predispose patients to poor outcomes. Anemia contributes to tissue hypoxia, reduced tolerance to surgical stress, and an impaired immune response, whereas malnutrition is linked to the loss of muscle mass (sarcopenia), impaired wound healing, and delayed postoperative recovery. Several studies have shown that preoperative anemia and undernutrition are closely associated with poor prognoses. Abu-Zaid et al. reported that preoperative anemia was associated with short OS in patients with EC [ 12 ]. Anemia can result from malabsorption, malnutrition, chronic bleeding, or bone marrow infiltration due to metastases, all of which negatively impact prognosis [ 13 , 14 ]. Aomatsu et al. showed that OS was significantly short in undernourished older patients undergoing colorectal cancer surgery [ 15 ]. Similarly, Zhao et al. reported that preoperative malnutrition and reduced muscle mass were associated with impaired immune function, physical decline, and poor prognoses in patients with advanced gastric cancer [ 16 ]. Collectively, these findings suggest that preoperative anemia and undernutrition are biologically linked to diminished immune function, sarcopenia, and impaired physical resilience. In our cohort, these vulnerabilities were associated with delayed postoperative recovery and poor survival outcomes. Importantly, they represent modifiable risk factors; preoperative identification followed by interventions such as nutritional support, correction of anemia, and perioperative rehabilitation may improve surgical resilience and long-term prognoses in older patients with EC. We also analyzed the surgical restriction group, in which no significant differences in the background factors were observed (Table 6). This may indicate that surgical decisions to limit procedures were made appropriately on a case-by-case basis, with the aim of preserving the quality of life of older patients with cancer. This study showed the high clinical significance of GA through a comprehensive analysis of multiple outcomes. Importantly, performing GA preoperatively allows clinicians to detect modifiable risk factors—such as anemia, malnutrition, or cognitive decline—that can be targeted by specific interventions, thereby improving surgical resilience and long-term prognoses. Previous studies have shown that preoperative anemia and undernutrition are associated with poor outcomes [ 12 , 15 ], underscoring the need for proactive perioperative management. In particular, a practical advantage is that risk stratification can be achieved with a short and simple assessment combining the G8 screening tool with routine laboratory parameters, such as hemoglobin and albumin. This streamlined approach makes GA feasible in daily clinical practice and enhances its applicability to busy clinical settings. Although our findings highlight the potential effect of GA on optimizing treatment strategies in older patients with cancer, further real-world data, including randomized controlled trials, are required to validate its usefulness and establish evidence-based guidelines. This study has several limitations. First, this was a single-institution retrospective analysis, and potential biases cannot be excluded, such as surgeon-dependent decision-making regarding surgical procedures and changes in institutional treatment policies over time. Second, the relatively small sample size and short follow-up period limit the generalizability of our findings. Furthermore, radiotherapy is often selected for cervical cancer, whereas for ovarian cancer, treatment options have become diverse owing to the introduction of neoadjuvant chemotherapy and variations in chemotherapy regimens, with postoperative chemotherapy having a significant impact on prognoses. In contrast, our study exclusively focused on EC to evaluate the effect of GA on perioperative management. Future research should address these limitations through prospective multicenter studies with larger sample sizes and longer follow-up periods. Interventional trials investigating the effectiveness of preoperative optimization strategies, such as nutritional support, anemia correction, and cognitive training, are warranted. Such studies are essential to validate the clinical utility of GA and to establish evidence-based strategies for improving outcomes in older patients with EC. Cognitive decline was associated with postoperative complications, whereas G8 abnormalities, preoperative anemia, and undernutrition were associated with poor survival in older patients with EC. A simple approach combining G8 screening with hemoglobin and albumin measurements may allow rapid risk stratification and guide targeted perioperative care. Further prospective multicenter studies are needed to validate these findings and confirm the clinical utility of GA. Declarations Author contributions S.H. and K.Y. designed the study. S.H., K.Y., S.S., R.Y., M.S., K.S., Y.O., N.W. and T.O. performed experiments. S.H., K.Y., S.N. analyzed the data. S.H., K.Y. and S.N. wrote the manuscript. All authors reviewed and approved the final version. Acknowledgements We appreciate the support of the clinical staff at the Yamagata University Hospital for their assistance with data collection. Ethics approval and consent to participate: This study was approved by the Institutional Review Board of Yamagata University (Approval No. 2022-197). Informed Consent: The requirement for informed consent was waived because of the retrospective study design. Consent for publication: Not applicable. Conflict of Interests: The authors declare no conflicts of interest. Data Availability Statement The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. References Japan CO (2024) Annual Report on the Ageing Society [Summary] FY2024 Cancer Information Service https://ganjoho.jp/reg_stat/index.html MARUOKA H (2019) Safety of laparoscopic surgery for elderly endometrial cancer patients, Advances in Obstetrics and Gynecology, 72 59–66 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 32:2595–2603 Kaibori M, Ishizaki M, Matsui K, Iida H, Inoue K, Nagashima F, Kon M (2016) Geriatric assessment as a predictor of postoperative complications in elderly patients with hepatocellular carcinoma. 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Am J Hematol 89:203–212 Aomatsu N, Maeda K, Fukui Y (2023) e. al., Nutritional indexes as predictors of postoperative complications and prognosis in elderly patients undergoing colorectal cancer surgery., Journal of the Anus, Rectum and Colon, 76 326–332 Zhao A, Hou C, Li Y, Liu Y (2023) Preoperative low muscle mass and malnutrition affect the clinical prognosis of locally advanced gastric cancer patients undergoing radical surgery. Front Oncol 13:1156359 Tables Tables are available in the Supplementary Files section. Supplementary Files shotahorikawaTable.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8208421","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":554941651,"identity":"832bd77e-9a25-4b70-97e5-73ae401be305","order_by":0,"name":"SHOTA 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15:16:24","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59008,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8208421/v1/6140e803c008d5b48a94d5fd.html"},{"id":97691399,"identity":"00ca3808-bf60-4860-b64c-fd1a23a62466","added_by":"auto","created_at":"2025-12-08 10:59:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":920048,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier-estimated PFS and OS for each GA item. We statistically analyzed by the Log-rank test. The vertical axis represents the disease-free survival rate or overall survival rate, and the horizontal axis represents the survival time (days). NR (Not Reached) means that the median has not been reached. P\u0026lt; .05 was considered statistically significant.\u003c/p\u003e","description":"","filename":"shotahorikawaFig1.png","url":"https://assets-eu.researchsquare.com/files/rs-8208421/v1/b0eb4288051547b5e5d7bff2.png"},{"id":97892795,"identity":"dfed5929-cce5-4a97-8822-a2e74c8e9658","added_by":"auto","created_at":"2025-12-10 15:21:52","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":676793,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier-estimated PFS and OS for surgical restriction. Same as in Fig1.\u003c/p\u003e","description":"","filename":"shotahorikawaFig2.png","url":"https://assets-eu.researchsquare.com/files/rs-8208421/v1/c89fdb966ec72c7815e99b0b.png"},{"id":98774586,"identity":"ec97507f-3502-454f-ad29-ed72f28e0a45","added_by":"auto","created_at":"2025-12-22 12:02:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2139096,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8208421/v1/bf1fc144-6253-4fbc-bf0e-e33652558f83.pdf"},{"id":97892572,"identity":"f2423148-3937-4402-88fd-c382904bbdf6","added_by":"auto","created_at":"2025-12-10 15:15:21","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":271470,"visible":true,"origin":"","legend":"","description":"","filename":"shotahorikawaTable.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8208421/v1/a1e6239d1d92fb1f5a006ef0.pdf"}],"financialInterests":"","formattedTitle":"The usefulness of geriatric assessment of older patients with Endometrial Cancer: our institutional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn Japan, the proportion of older individuals has markedly increased owing to the declining birth rate and improvements in life expectancy. While older individuals (\u0026ge;\u0026thinsp;65 years) accounted for \u0026lt;\u0026thinsp;5% of the population in 1950, this rate increased to 29.1% in 2023 and is projected to reach 38.7% by 2070, one of the highest aging rates worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In parallel, cancer-related deaths among older individuals increased from 80.4% in 2010 to 88.4% in 2023, and this proportion is expected to continue to increase [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOlder patients with cancer often present with organ dysfunction, comorbidities, and geriatric syndromes, which increase the risk of treatment-related adverse events and impair their quality of life. They are highly susceptible to surgical complications, such as ureteral or intestinal injuries, and age-specific conditions, including dementia, delirium, and functional decline, which may interfere with treatment. A previous study has shown that postoperative delirium was significantly more frequent in patients with endometrial cancer (EC) who were aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years than in younger patients (14% vs. 1.6%) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Given these vulnerabilities, older patients with cancer are frequently excluded from clinical trials, underscoring the urgent need for evidence-based research tailored to this population.\u003c/p\u003e\u003cp\u003eGeriatric assessment (GA) is a multidimensional tool that evaluates comorbidities, nutrition, cognition, functional status, and geriatric syndromes, enabling the identification of patients at high risk of adverse outcomes and guiding management decisions [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among GA instruments, the G8 screening tool has been associated with postoperative complications in patients with hepatocellular carcinoma aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and with short overall survival (OS) across older populations with cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, evidence specifically addressing the role of GA in gynecological cancers remains limited.\u003c/p\u003e\u003cp\u003eTherefore, we aimed to investigate the relationship between GA and treatment-related complications and prognosis in older patients with EC at our institution.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatients\u003c/h2\u003e\u003cp\u003eWe retrospectively analyzed patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with EC who underwent surgery at the Yamagata University Hospital between July 2020 and April 2024.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGeriatric assessment\u003c/h3\u003e\n\u003cp\u003ePreoperative geriatric assessment (GA) was performed and included the following domains: G8 screening tool (17-point score; \u0026lt;14 defined as abnormal), Instrumental Activities of Daily Living (IADL; 8-point female version; \u0026lt;7 defined as impaired), Charlson Comorbidity Index (CCI; \u0026ge;3 defined as comorbidity), residential status (living alone or not), and Mini-Cog test (three-word recall and clock-drawing test; impaired if criteria were met).\u003c/p\u003e\n\u003ch3\u003eClinical factors\u003c/h3\u003e\n\u003cp\u003eThe following variables were also evaluated: age at diagnosis, disease stage, preoperative anemia (hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;11.6 g/dL), preoperative undernutrition (albumin\u0026thinsp;\u0026lt;\u0026thinsp;4.0 g/dL), postoperative complications, postoperative delirium, and survival outcomes (progression-free survival [PFS] and OS). Postoperative complications were defined as grade\u0026thinsp;\u0026ge;\u0026thinsp;2 according to the Clavien\u0026ndash;Dindo classification (Table\u0026nbsp;1). Surgical restriction was defined as the omission of lymph node dissection based on the institutional criteria (Table\u0026nbsp;2).\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eComparisons between groups were performed using Fisher\u0026rsquo;s exact test, chi-square test, and log-rank test. Analyses were conducted using the EZR software. p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthics statement\u003c/h3\u003e\n\u003cp\u003e This study was approved by the Ethics Committee of Yamagata University Faculty of Medicine (approval no.: 2022\u0026thinsp;\u0026minus;\u0026thinsp;197). The requirement for informed consent was waived because of the retrospective study design.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePatient characteristics\u003c/h2\u003e\u003cp\u003eWe analyzed 41 patients with EC aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years who underwent surgery. The median age at diagnosis was 68 years (range, 65\u0026ndash;86), and 13 patients (32%) were aged\u0026thinsp;\u0026ge;\u0026thinsp;75 years. The median body mass index was 26.8 kg/m\u0026sup2; (range, 20.4\u0026ndash;33.3), and 18 patients (44%) had body mass index\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;. The median follow-up period for the entire cohort was 769 days (range, 43\u0026ndash;1647). Early stage disease was predominant; 29 patients (70%) had Stage II or lower disease, with Stage IA/IB comprising the majority. Based on the institutional criteria, 16 patients (39%) underwent surgical restriction (omission of lymph node dissection). The baseline characteristics of the patients are summarized in Table\u0026nbsp;3.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGA domains and preoperative factors\u003c/h3\u003e\n\u003cp\u003ePreoperative GA identified the following: abnormal G8 scores in 16 patients (39%), impaired IADL in 6 (15%), CCI\u0026thinsp;\u0026ge;\u0026thinsp;3 in 8 (19%), living alone in 6 (15%), and cognitive impairment on Mini-Cog in 6 (15%). Preoperative anemia (hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;11.6 g/dL) was present in 4 patients (10%), and undernutrition (albumin\u0026thinsp;\u0026lt;\u0026thinsp;4.0 g/dL) was present in 9 patients (22%). One patient had missing data on IADL, residential status, and Mini-Cog (percentages calculated from non-missing data).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePostoperative complications and delirium\u003c/h2\u003e\u003cp\u003ePostoperative complications occurred in 23 patients (56%). Complications were significantly more frequent among patients with cognitive impairment than among those without (p\u0026thinsp;=\u0026thinsp;0.027), whereas no significant associations were observed for other GA domains (Table\u0026nbsp;4). Complication rates did not differ significantly according to the surgical restriction status (48% vs. 28%, p\u0026thinsp;=\u0026thinsp;0.22). Constipation/bowel obstruction was the most common event; 19 patients (46%) required laxatives. Postoperative delirium occurred in 4 patients (10%) and was not associated with GA domains or surgical restriction.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eRecurrence and survival\u003c/h2\u003e\u003cp\u003eThirteen patients (32%) experienced recurrence, with a higher incidence in the dementia group than in the group without dementia (31% vs. 7%, p\u0026thinsp;=\u0026thinsp;0.055). Eleven deaths (27%) occurred: 10 due to EC progression and one due to concomitant cholangiocarcinoma. Stage III or IV disease was associated with a high recurrence rate (54% vs. 18%, p\u0026thinsp;=\u0026thinsp;0.029) and a high mortality rate (55% vs. 20%, p\u0026thinsp;=\u0026thinsp;0.052). The event proportions did not differ significantly between patients with and without surgical restrictions (recurrence: 54% vs. 32%, p\u0026thinsp;=\u0026thinsp;0.33; death: 64% vs. 30%, p\u0026thinsp;=\u0026thinsp;0.074) (Table\u0026nbsp;5).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTime-to-event outcomes\u003c/h2\u003e\u003cp\u003ePFS was significantly shorter in patients with abnormal G8 scores, cognitive impairment, and anemia than in those without (G8: median 613 days [211\u0026ndash;NR] vs. NR [589\u0026ndash;NR], p\u0026thinsp;=\u0026thinsp;0.029; dementia: 288 days [42\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.015; anemia: 241 days [153\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.015). OS showed a non-significant shortening trend in the abnormal G8 score group (NR [589\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.196). In contrast, OS was significantly shorter in patients with anemia and undernutrition than in those without (anemia: 610 days [325\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.016; undernutrition: 589 days [325\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.043) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eSurgical restriction subgroup\u003c/h2\u003e\u003cp\u003ePFS tended to be shorter in the surgical restriction group than in the group without surgical restriction; however, the difference was not statistically significant (646 days [302\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.21). In contrast, OS was significantly shorter in the surgical restriction group than in the group without surgical restriction (1189 days [477\u0026ndash;NR] vs. NR, p\u0026thinsp;=\u0026thinsp;0.016) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The background factors did not differ significantly between the groups with and without surgical restriction (Table\u0026nbsp;6).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this institutional study, we investigated the association between GA and postoperative complications and prognosis in older patients with EC. Abnormal G8 scores, cognitive decline, preoperative anemia, and undernutrition were significantly associated with poor outcomes. Cognitive decline was associated with postoperative complications.\u003c/p\u003e\u003cp\u003eGA has been widely proposed as an inclusive framework for capturing the heterogeneity of cancer in older adults, and its clinical utility has been reported across various tumor types. Several studies have shown that GA is associated with the prognosis of patients with cancer. Kenis et al. reported that G8 abnormalities significantly shortened OS in patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years across all cancer types and that G8 screening may serve as a predictor of prognosis not only for patients undergoing surgery but also for patients undergoing chemotherapy and radiotherapy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In addition to these mixed cancer cohorts and hepatocellular carcinoma, where Kaibori et al. showed that abnormal G8 scores predicted postoperative complications [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], gynecological oncology-specific data are emerging. Michaan et al. demonstrated that comprehensive GA correlated with OS in gynecological malignancies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], whereas Puviani et al. reported that preoperative G8 abnormalities predicted postoperative complications in patients with gynecological cancer [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Consistent with these findings, in our EC-only cohort, we observed that GA vulnerabilities were linked to adverse outcomes: abnormal G8 scores were associated with short PFS, and cognitive impairment was associated with postoperative complications. Unlike previous studies that have shown significant associations between GA and OS, we did not observe such an association in our study cohort. This discrepancy may be explained by disease site restriction to EC, relatively small sample size, predominance of earlier stages, short follow-up duration, reliance on G8 screening rather than full GA, and potential institutional selection criteria for surgical indications. Taken together, our findings are directionally consistent with the gynecological oncology literature while adding site-specific evidence for EC and highlighting GA domains (G8, cognition, anemia, and undernutrition) that may be the most informative for perioperative risk stratification and prognosis.\u003c/p\u003e\u003cp\u003eIn our study, the dementia group experienced postoperative complications, most of which included constipation or bowel obstruction. Although no patient experienced complications above grade III according to the Clavien\u0026ndash;Dindo classification, and most cases were grade II or below, these events still affected postoperative recovery. Cognitive decline may contribute to such complications through several mechanisms, including decreased physical activity and mobility after surgery, reduced self-management and responsiveness to bowel symptoms, and inadequate oral intake (including insufficient hydration). In addition, polypharmacy and constipation medications are common in patients with cognitive impairment, which may further predispose them to postoperative bowel dysfunction. These combined factors likely explain why constipation and bowel obstruction were more frequently observed in patients with cognitive impairment than in those without.\u003c/p\u003e\u003cp\u003eIn addition to postoperative morbidity, dementia has been associated with poor long-term survival. Raji et al. reported that preexisting dementia is associated with increased mortality in breast, colon, and prostate cancers, often due to non-cancer causes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Dementia may worsen prognosis through complications such as aspiration and delirium, difficulty in obtaining informed consent, and reduced recognition of subjective symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In our study, patients in the dementia group tended to be older and had advanced disease at diagnosis, which may partly explain their poor prognoses. These findings suggest that delayed presentation due to a lack of symptom recognition could be a contributory factor.\u003c/p\u003e\u003cp\u003eIn addition, a previous report showed that OS was associated with the Geriatric Vulnerability Score, which included albuminemia\u0026thinsp;\u0026lt;\u0026thinsp;35 g/L, Activities of Daily Living score\u0026thinsp;\u0026lt;\u0026thinsp;6, IADL score\u0026thinsp;\u0026lt;\u0026thinsp;25, lymphopenia\u0026thinsp;\u0026lt;\u0026thinsp;1 G/L, and Hospital Anxiety and Depression Scale score\u0026thinsp;\u0026gt;\u0026thinsp;14, in patients with advanced (Stages III\u0026ndash;IV) ovarian cancer aged\u0026thinsp;\u0026gt;\u0026thinsp;70 years [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Moreover, OS was associated with cognitive function in patients with gynecological cancer [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Our findings further highlight that anemia and malnutrition are not only markers of frailty but may also predispose patients to poor outcomes. Anemia contributes to tissue hypoxia, reduced tolerance to surgical stress, and an impaired immune response, whereas malnutrition is linked to the loss of muscle mass (sarcopenia), impaired wound healing, and delayed postoperative recovery.\u003c/p\u003e\u003cp\u003eSeveral studies have shown that preoperative anemia and undernutrition are closely associated with poor prognoses. Abu-Zaid et al. reported that preoperative anemia was associated with short OS in patients with EC [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Anemia can result from malabsorption, malnutrition, chronic bleeding, or bone marrow infiltration due to metastases, all of which negatively impact prognosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Aomatsu et al. showed that OS was significantly short in undernourished older patients undergoing colorectal cancer surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Similarly, Zhao et al. reported that preoperative malnutrition and reduced muscle mass were associated with impaired immune function, physical decline, and poor prognoses in patients with advanced gastric cancer [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eCollectively, these findings suggest that preoperative anemia and undernutrition are biologically linked to diminished immune function, sarcopenia, and impaired physical resilience. In our cohort, these vulnerabilities were associated with delayed postoperative recovery and poor survival outcomes. Importantly, they represent modifiable risk factors; preoperative identification followed by interventions such as nutritional support, correction of anemia, and perioperative rehabilitation may improve surgical resilience and long-term prognoses in older patients with EC.\u003c/p\u003e\u003cp\u003eWe also analyzed the surgical restriction group, in which no significant differences in the background factors were observed (Table\u0026nbsp;6). This may indicate that surgical decisions to limit procedures were made appropriately on a case-by-case basis, with the aim of preserving the quality of life of older patients with cancer.\u003c/p\u003e\u003cp\u003eThis study showed the high clinical significance of GA through a comprehensive analysis of multiple outcomes. Importantly, performing GA preoperatively allows clinicians to detect modifiable risk factors\u0026mdash;such as anemia, malnutrition, or cognitive decline\u0026mdash;that can be targeted by specific interventions, thereby improving surgical resilience and long-term prognoses. Previous studies have shown that preoperative anemia and undernutrition are associated with poor outcomes [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], underscoring the need for proactive perioperative management. In particular, a practical advantage is that risk stratification can be achieved with a short and simple assessment combining the G8 screening tool with routine laboratory parameters, such as hemoglobin and albumin. This streamlined approach makes GA feasible in daily clinical practice and enhances its applicability to busy clinical settings. Although our findings highlight the potential effect of GA on optimizing treatment strategies in older patients with cancer, further real-world data, including randomized controlled trials, are required to validate its usefulness and establish evidence-based guidelines.\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, this was a single-institution retrospective analysis, and potential biases cannot be excluded, such as surgeon-dependent decision-making regarding surgical procedures and changes in institutional treatment policies over time. Second, the relatively small sample size and short follow-up period limit the generalizability of our findings. Furthermore, radiotherapy is often selected for cervical cancer, whereas for ovarian cancer, treatment options have become diverse owing to the introduction of neoadjuvant chemotherapy and variations in chemotherapy regimens, with postoperative chemotherapy having a significant impact on prognoses. In contrast, our study exclusively focused on EC to evaluate the effect of GA on perioperative management.\u003c/p\u003e\u003cp\u003eFuture research should address these limitations through prospective multicenter studies with larger sample sizes and longer follow-up periods. Interventional trials investigating the effectiveness of preoperative optimization strategies, such as nutritional support, anemia correction, and cognitive training, are warranted. Such studies are essential to validate the clinical utility of GA and to establish evidence-based strategies for improving outcomes in older patients with EC.\u003c/p\u003e\u003cp\u003eCognitive decline was associated with postoperative complications, whereas G8 abnormalities, preoperative anemia, and undernutrition were associated with poor survival in older patients with EC. A simple approach combining G8 screening with hemoglobin and albumin measurements may allow rapid risk stratification and guide targeted perioperative care. Further prospective multicenter studies are needed to validate these findings and confirm the clinical utility of GA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.H. and K.Y. designed the study. S.H., K.Y., S.S., R.Y., M.S., K.S., Y.O., N.W. and T.O. performed experiments. S.H., K.Y., S.N. analyzed the data. S.H., K.Y. and S.N. wrote the manuscript. All authors reviewed and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe appreciate the support of the clinical staff at the Yamagata University Hospital for their assistance with data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003cbr\u003e\u003c/strong\u003eThis study was approved by the Institutional Review Board of Yamagata University (Approval No. 2022-197).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe requirement for informed consent was waived because of the retrospective study design.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003cbr\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJapan CO (2024) Annual Report on the Ageing Society [Summary] FY2024\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCancer Information Service \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ganjoho.jp/reg_stat/index.html\u003c/span\u003e\u003cspan address=\"https://ganjoho.jp/reg_stat/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMARUOKA H (2019) Safety of laparoscopic surgery for elderly endometrial cancer patients, Advances in Obstetrics and Gynecology, 72 59\u0026ndash;66\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWildiers 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 32:2595\u0026ndash;2603\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaibori M, Ishizaki M, Matsui K, Iida H, Inoue K, Nagashima F, Kon M (2016) Geriatric assessment as a predictor of postoperative complications in elderly patients with hepatocellular carcinoma. Langenbecks Arch Surg 401:205\u0026ndash;214\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKenis C, Decoster L, Van Puyvelde K, De Greve J, Conings G, Milisen K, Flamaing J, Lobelle JP, Wildiers H (2014) Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol 32:19\u0026ndash;26\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMichaan N, Park SY, Lim MC (2020) Comprehensive geriatric assessment is correlated to overall survival among gynaecologic oncology patients. Jpn J Clin Oncol 50:276\u0026ndash;281\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ee.a. Filippo Cioli Puviani, Pre-operative geriatric screening and assessment as predictors of postoperative complications in older adults with gynecologic cancer: A pilot cohort study on a neglected issue, Journal of Geriatric Oncology, 14 (2023)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRaji MA, Kuo YF, Freeman JL, Goodwin JS (2008) Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Arch Intern Med 168:2033\u0026ndash;2040\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoshida Y (2020) Current Status and Problems in the Treatment of Gynecological Cancer in the Elderly. J Japan Soc Gynecologic Oncol, 83\u0026ndash;92\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFalandry C, Weber B, Savoye AM, Tinquaut F, Tredan O, Sevin E, Stefani L, Savinelli F, Atlassi M, Salvat J, Pujade-Lauraine E, Freyer G (2013) Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial. Ann Oncol 24:2808\u0026ndash;2813\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbu-Zaid A, Alomar O, Abuzaid M, Baradwan S, Salem H, Al-Badawi IA (2021) Preoperative anemia predicts poor prognosis in patients with endometrial cancer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 258:382\u0026ndash;390\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBusti F, Marchi G, Ugolini S, Castagna A, Girelli D (2018) Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy. Pharmaceuticals (Basel), 11\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGilreath JA, Stenehjem DD, Rodgers GM (2014) Diagnosis and treatment of cancer-related anemia. Am J Hematol 89:203\u0026ndash;212\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAomatsu N, Maeda K, Fukui Y (2023) e. al., Nutritional indexes as predictors of postoperative complications and prognosis in elderly patients undergoing colorectal cancer surgery., Journal of the Anus, Rectum and Colon, 76 326\u0026ndash;332\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao A, Hou C, Li Y, Liu Y (2023) Preoperative low muscle mass and malnutrition affect the clinical prognosis of locally advanced gastric cancer patients undergoing radical surgery. Front Oncol 13:1156359\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"geriatric assessment, endometrial cancer, G8 score, cognitive decline, anemia, undernutrition","lastPublishedDoi":"10.21203/rs.3.rs-8208421/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8208421/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOlder patients with cancer are at an increased risk of treatment-related complications and poor survival. However, evidence of the usefulness of geriatric assessment (GA) in gynecological oncology remains limited. We aimed to investigate the relationship between GA and treatment-related complications and prognosis in older patients with endometrial cancer at our institution.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe retrospectively analyzed 41 patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years with endometrial cancer who underwent surgery at our institution between July 2020 and April 2024. Preoperative GA included the G8 score, Instrumental Activities of Daily Living, Charlson Comorbidity Index, residential status, and Mini-Cog test. We also evaluated preoperative anemia, undernutrition, postoperative complications, delirium, and survival outcomes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAbnormal G8 scores and cognitive decline were observed in 39% and 15% of patients, respectively. Postoperative complications occurred more frequently in patients with cognitive impairment than in those without (p\u0026thinsp;=\u0026thinsp;0.027). Progression-free survival was significantly shorter in patients with abnormal G8 scores (p\u0026thinsp;=\u0026thinsp;0.029), cognitive impairment (p\u0026thinsp;=\u0026thinsp;0.015), and anemia (p\u0026thinsp;=\u0026thinsp;0.015) than in those without. Overall survival was significantly shorter in patients with anemia (p\u0026thinsp;=\u0026thinsp;0.016) and undernutrition (p\u0026thinsp;=\u0026thinsp;0.043) than in those without.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGA was significantly associated with postoperative complications and survival outcomes in older patients with endometrial cancer. Abnormal G8 scores, cognitive impairment, preoperative anemia, and undernutrition are useful prognostic factors. Incorporating GA into routine preoperative evaluations could help to identify high-risk patients and guide personalized treatment strategies in gynecological oncology.\u003c/p\u003e","manuscriptTitle":"The usefulness of geriatric assessment of older patients with Endometrial Cancer: our institutional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 10:59:03","doi":"10.21203/rs.3.rs-8208421/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d51e0eb0-3326-40cc-9507-8e28c491e657","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T03:43:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 10:59:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8208421","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8208421","identity":"rs-8208421","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}