Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2011 Nov;123(2):187-91. doi: 10.1016/j.ygyno.2011.06.031. Epub 2011 Jul 26.
To assess outcomes and identify underlying predictors of outcomes in a cohort of women over the age of 65 treated for primary ovarian cancer (OC).
Consecutive patients ≥ 65 with stage IIIC or IV OC treated with primary surgery and adjuvant chemotherapy at Mayo Clinic between January 1, 1994 and December 31, 2004 were retrospectively assessed. We analyzed the impact of perioperative factors (age, albumin, CA125, American Society of Anesthesiologist (ASA) score, amount of ascites, presence of carcinomatosis, creatinine, need for urgent surgery, stage of disease, surgical complexity score and amount of residual disease) on surgical outcomes (morbidity, mortality, overall survival (OS) and ability to receive chemotherapy).
Two hundred eighty patients met inclusion criteria. Age was associated with higher ASA score, lower albumin, and higher creatinine; stage, diffuse peritoneal disease, and surgical complexity were not associated with age. Median OS decreased with increasing age and residual disease (RD), and the impact of RD was greater on older patients. All patients benefited similarly when RD=0 [median OS 5.9 years for age 65-69 vs. 5.0 years in those ≥ 80 (p=0.5516)], for RD<1cm, and OS was 3.4 vs. 2.1 years respectively for youngest vs. oldest patients (p=0.068). Perioperative morbidity was observed in 37.5% of patients ≥ 75. Independent predictors of poor perioperative outcome included preoperative albumin ≤ 3g/dL, urgent surgery, age, and stage (p<0.05). Independent predictors of overall survival included creatinine, albumin, surgical complexity score, amount of residual disease, stage and age.
Age is an independent predictor of OS in OC. A significant number of elderly women are able to undergo a complete cytoreduction and experience OS similar to that of younger patients. However, the benefits to incomplete cytoreduction are less clear in women ≥ 75. These observations highlight the need to use emerging predictors of outcomes in decision making and to focus care in centers able to render patients with no visible residual disease.
评估年龄在 65 岁以上接受原发性卵巢癌 (OC) 治疗的女性队列的结局，并确定影响结局的潜在预测因素。
回顾性分析 1994 年 1 月 1 日至 2004 年 12 月 31 日在梅奥诊所接受原发性手术和辅助化疗治疗的年龄在 65 岁以上的 IIIC 期或 IV 期 OC 连续患者。我们分析了围手术期因素（年龄、白蛋白、CA125、美国麻醉师协会（ASA）评分、腹水量、癌性腹水、肌酐、是否需要紧急手术、疾病分期、手术复杂评分和残留病灶量）对手术结局（发病率、死亡率、总生存（OS）和接受化疗的能力）的影响。
280 名患者符合纳入标准。年龄与较高的 ASA 评分、较低的白蛋白和较高的肌酐相关；而分期、弥漫性腹膜疾病和手术复杂性与年龄无关。随着年龄和残留病灶（RD）的增加，中位 OS 降低，RD 的影响在老年患者中更大。当 RD=0 时，所有患者均受益[年龄 65-69 岁的中位 OS 为 5.9 年，而年龄≥80 岁的患者为 5.0 年（p=0.5516）]，对于 RD<1cm，最年轻患者和最年长患者的 OS 分别为 3.4 年和 2.1 年（p=0.068）。≥75 岁的患者中观察到 37.5%的患者出现围手术期并发症。术前白蛋白≤3g/dL、紧急手术、年龄和分期是围手术期不良结局的独立预测因素（p<0.05）。总生存的独立预测因素包括肌酐、白蛋白、手术复杂评分、残留病灶量、分期和年龄。
年龄是 OC 患者 OS 的独立预测因素。相当数量的老年女性能够进行完全肿瘤细胞减灭术，并获得与年轻患者相似的 OS。然而，在≥75 岁的女性中，不完全肿瘤细胞减灭术的获益不太明确。这些观察结果强调需要在决策中使用新出现的结局预测因素，并将护理重点放在能够使患者无可见残留病灶的中心。
