Perri Tamar, Katz Tanya, Korach Jacob, Beiner Mario E, Jakobson-Setton Ariella, Ben-Baruch Gilad
*Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Am J Clin Oncol. 2015 Jun;38(3):278-82. doi: 10.1097/COC.0b013e318297d464.
To determine the relative benefits of full and partial treatment for gynecologic malignancies in elderly patients.
A retrospective cohort study of all consecutive patients (n=169) aged 79 and older (median age 82 y; range, 79 to 94 y), diagnosed between 1971 and 2007 with various types of gynecologic malignancies (endometrial, 52%; ovarian, 26%; vulvar, 11%; cervical, 5%; other, 6%) was conducted. Stages were I to II (47%), III to IV (35.5%), and unknown (17.5%). Major comorbidities were hypertension (51%), diabetes (17%), cardiac diseases (34%), and other malignancy (12%). Regardless of age or chronic illnesses, patients were grouped on the basis of having been treated optimally (100 patients; 59.2%), defined as the accepted standard for each diagnosis and stage including surgery and adjuvant radiation or chemotherapy as indicated; or suboptimally (69 patients; 40.8%), that is, no or only partial treatment. Kaplan-Meier survival analysis and Cox proportional hazard models, univariate and multivariable were conducted.
For all patients with suboptimal treatment, the age-and-stage-adjusted hazard ratio for death was 1.76 (95% CI, 1.203-2.570; P=0.004) compared with optimal treatment. Age-adjusted hazard ratio was 2.15 (95% CI, 1.127-4.114; P=0.02) and 2.3 (95% CI, 1.415-3.779; P=0.001) for ovarian and endometrial cancer patients, respectively. Age-adjusted and stage-adjusted hazard ratio was 2.8 (95% CI, 1.099-5.157; P=0.028) and 1.53 (95% CI, 0.867-2.702; P=0.1420) for ovarian and endometrial cancer patients, respectively.
Optimal treatment in patients with gynecologic malignancies evidently improves survival in elderly patients at any age, and in patients with ovarian cancer at any stage. Regardless of chronological age, the aim should be to deliver optimal treatment.
确定老年妇科恶性肿瘤患者接受全疗程治疗和部分疗程治疗的相对获益情况。
对1971年至2007年间连续诊断为各种类型妇科恶性肿瘤（子宫内膜癌，52%；卵巢癌，26%；外阴癌，11%；宫颈癌，5%；其他，6%）的所有79岁及以上（中位年龄82岁；范围79至94岁）患者（n = 169）进行回顾性队列研究。分期为Ⅰ至Ⅱ期（47%）、Ⅲ至Ⅳ期（35.5%）和分期不明（17.5%）。主要合并症为高血压（51%）、糖尿病（17%）、心脏病（34%）和其他恶性肿瘤（12%）。无论年龄或慢性病情况如何，患者根据是否接受了最佳治疗分组（100例患者；59.2%），最佳治疗定义为每种诊断和分期的公认标准，包括手术及根据情况进行辅助放疗或化疗；或接受了次优治疗（69例患者；40.8%），即未接受治疗或仅接受了部分治疗。进行了单变量和多变量的Kaplan-Meier生存分析及Cox比例风险模型分析。
与最佳治疗相比，所有接受次优治疗的患者，年龄和分期调整后的死亡风险比为1.76（95%可信区间，1.203 - 2.570；P = 0.004）。卵巢癌和子宫内膜癌患者的年龄调整后风险比分别为2.15（95%可信区间，1.127 - 4.114；P = 0.02）和2.3（95%可信区间，1.415 - 3.779；P = 0.001）。卵巢癌和子宫内膜癌患者的年龄和分期调整后风险比分别为2.8（95%可信区间，1.099 - 5.157；P = 0.028）和1.53（95%可信区间，0.867 - 2.702；P = 0.1420）。
妇科恶性肿瘤患者接受最佳治疗显然可提高各年龄段老年患者以及各分期卵巢癌患者的生存率。无论实际年龄如何，目标都应是提供最佳治疗。
