Wright Jason D, Gibb Randall K, Geevarghese Sajeena, Powell Matthew A, Herzog Thomas J, Mutch David G, Grigsby Perry W, Gao Feng, Trinkaus Kathryn M, Rader Janet S
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Cancer. 2005 Jan 1;103(1):85-91. doi: 10.1002/cncr.20751.
Advanced age often is considered a poor prognostic factor for cervical carcinoma. The authors investigated the patterns of care and treatment outcomes of elderly women with cervical carcinoma.
A hospital-based tumor registry was used to identify patients with invasive cervical carcinoma who were treated between 1986 and 2003. Patients were divided into 2 cohorts: women age < 70 years and women age > or = 70 years. Survival was examined using the Kaplan-Meier method. Single and multivariate Cox proportional hazards modeling was used to estimate hazard ratios with 95% confidence intervals (95% CI).
In total, 1582 patients were identified, including 1385 patients age < 70 years and 197 patients age > or = 70 years. The elderly patients presented with more advanced stage tumors at diagnosis (P <0.0001) and were more likely to have nonsquamous neoplasms (P=0.002). A marked difference in treatment was noted for the elderly cohort, even after stratifying by disease stage. Only 16% of the older patients underwent surgical treatment compared with 54% of the younger patients (P <0.0001). Elderly women were 9 times more likely to receive no treatment (P <0.0001). In a multivariate model of known prognostic factors, the hazard ratio for death from any cause in women age > 70 years was 2.1 (95% CI, 1.5-3.0). The hazard ratio for death from cervical carcinoma in the elderly women was 1.6 (95% CI, 1.1-2.5).
Age is an important factor in the allocation of treatment and survival for patients with cervical carcinoma. Elderly women with cervical carcinoma are more likely to receive primary radiotherapy, to forego treatment, and to die from their disease.
高龄常被视为宫颈癌预后不良的因素。作者调查了老年宫颈癌女性的治疗模式和治疗结果。
利用基于医院的肿瘤登记系统识别1986年至2003年间接受治疗的浸润性宫颈癌患者。患者分为两个队列：年龄<70岁的女性和年龄≥70岁的女性。采用Kaplan-Meier法检查生存率。使用单因素和多因素Cox比例风险模型估计风险比及95%置信区间（95%CI）。
共识别出1582例患者，其中1385例年龄<70岁，197例年龄≥70岁。老年患者在诊断时肿瘤分期更晚（P<0.0001），且更易患非鳞状肿瘤（P=0.002）。即使按疾病分期分层，老年队列的治疗也存在显著差异。只有16%的老年患者接受了手术治疗，而年轻患者为54%（P<0.0001）。老年女性未接受治疗的可能性是年轻女性的9倍（P<0.0001）。在已知预后因素的多因素模型中，70岁以上女性任何原因死亡的风险比为2.1（95%CI，1.5-3.0）。老年女性宫颈癌死亡的风险比为1.6（95%CI，1.1-2.5）。
年龄是宫颈癌患者治疗分配和生存的重要因素。老年宫颈癌女性更有可能接受根治性放疗、放弃治疗并死于该疾病。
