Wimberger Pauline, Lehmann Nils, Kimmig Rainer, Burges Alexander, Meier Werner, Hoppenau Berit, du Bois Andreas
Department of Gynecology and Obstetrics, University of Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Gynecol Oncol. 2006 Feb;100(2):300-7. doi: 10.1016/j.ygyno.2005.08.029. Epub 2005 Sep 29.
Ovarian cancer exhibits the highest mortality rate among gynecologic cancer and survival rates vary considerably by age. Therefore, we investigated impact of age on outcome in advanced ovarian cancer.
We performed a subgroup-analysis concerning influence of age classified according to three categories: younger patients (YP; <50 years) vs. middle-aged patients (MP; 50-65 years) vs. elderly patients (EP; >65 years). 686 patients with FIGO IIB-IV were treated within a prospectively randomized phase III study (AGO-OVAR 3) comparing cisplatin-paclitaxel vs. carboplatin-paclitaxel. This subgroup-analysis consisted of patients with homogeneous histology and complete surgical data.
YP had statistically more often achieved no residual tumor after primary surgery than MP and EP (P < 0.0001) resulting in improved median overall survival: 60.7, 41.3, and 33.2 months for YP, MP, and EP, respectively. The survival advantage of YP compared to EP remained significant even in completely debulked patients. Multivariable analysis revealed age being an independent prognostic factor.
Reduced surgical radicality, that means both less optimal debulking and also less radical surgery, contributes to poorer outcome in elderly patients with advanced ovarian cancer. However, age-specific surgical approaches did only partially explain age-dependent outcome. Therefore, generalization of study results to all patient age groups might be limited and further studies should focus specifically on treatment in elderly patients.
卵巢癌在妇科癌症中死亡率最高，生存率因年龄差异很大。因此，我们研究了年龄对晚期卵巢癌预后的影响。
我们进行了一项亚组分析，根据年龄分为三类：年轻患者（YP；<50岁）、中年患者（MP；50 - 65岁）和老年患者（EP；>65岁），探讨年龄的影响。686例国际妇产科联盟（FIGO）IIB - IV期患者在一项前瞻性随机III期研究（AGO - OVAR 3）中接受治疗，该研究比较顺铂 - 紫杉醇与卡铂 - 紫杉醇。这项亚组分析纳入了组织学相同且手术数据完整的患者。
YP在初次手术后无残留肿瘤的比例在统计学上高于MP和EP（P < 0.0001），中位总生存期得到改善：YP、MP和EP分别为60.7个月、41.3个月和33.2个月。即使在完全减瘤的患者中，YP与EP相比的生存优势仍然显著。多变量分析显示年龄是一个独立的预后因素。
手术根治性降低，即减瘤效果欠佳和手术不够彻底，导致老年晚期卵巢癌患者预后较差。然而，针对不同年龄的手术方法仅部分解释了年龄依赖性预后。因此，将研究结果推广到所有患者年龄组可能存在局限性，进一步研究应特别关注老年患者的治疗。
