Curr Treat Options Oncol. 2013 Mar;14(1):12-21. doi: 10.1007/s11864-012-0216-2.
Elderly patients with advanced epithelial ovarian cancer present a complex treatment dilemma. On the one hand, patients can be treated with primary debulking surgery to achieve the ideal oncologic outcomes but at the expense of risk of surgical morbidity and mortality. On the other hand, they can be treated with alternative, less morbid approaches, reducing toxicity, but sacrificing the survival benefits of low residual disease by surgical cytoreduction. Retrospective studies have attempted to identify risk factors for poor surgical outcome. Although there is no consensus to define "elderly" or "frail," current evidence identifies age, performance status, nutritional status, and surgical complexity as major risk factors for surgical morbidity. Accepting the shortcomings of these retrospective data, candidates for primary debulking surgery can be assessed for risk of surgical morbidity. Age is likely a contributor to morbidity, particularly in the face of comorbid conditions. Clinicians should strive to treat elderly patients with a standard approach of primary debulking surgery and adjuvant chemotherapy when healthy and in the absence of other risk factors. Elderly patients with the following are poor surgical candidates and an alternative treatment approach should be considered: poor nutritional status (characterized by serum albumin <3.0 g/dL), or poor performance status (ASA ≥3), and stage IV disease. Several of these factors are modifiable by treating the underlying cancer. These patients should be treated with two to three cycles of neoadjuvant chemotherapy and reassessed for surgical debulking. Patients with improvement in their nutritional or performance status can undergo interval debulking with the goal to resect all visible disease.
老年晚期上皮性卵巢癌患者面临复杂的治疗困境。一方面，患者可以接受初次肿瘤细胞减灭术治疗，以达到理想的肿瘤学疗效，但要承担手术发病率和死亡率增加的风险。另一方面，患者也可以选择接受其他侵袭性较小的方法，降低毒性，但会牺牲手术减瘤带来的生存获益。回顾性研究试图确定手术结局不良的风险因素。尽管目前尚无定义“老年”或“虚弱”的共识，但现有证据表明，年龄、体能状态、营养状况和手术复杂性是手术发病率的主要危险因素。尽管这些回顾性数据存在局限性，但可以对接受初次肿瘤细胞减灭术的患者进行手术发病率风险评估。年龄可能是发病率的一个促成因素，尤其是在存在合并症的情况下。在患者健康且无其他风险因素的情况下，临床医生应努力采用初次肿瘤细胞减灭术和辅助化疗的标准方法治疗老年患者。存在以下情况的老年患者不适合手术，应考虑其他治疗方法：营养状况差（血清白蛋白<3.0 g/dL）、体能状态差（ASA≥3 级）和 IV 期疾病。这些因素中的一些可以通过治疗基础癌症来改变。这些患者应接受两到三个周期的新辅助化疗，并重新评估手术减瘤情况。如果患者的营养或体能状态得到改善，可以进行间隔性肿瘤细胞减灭术，目标是切除所有可见的肿瘤。
