Ferrero Annamaria, Fuso Luca, Tripodi Elisa, Tana Roberta, Daniele Alberto, Zanfagnin Valentina, Perotto Stefania, Gadducci Angiolo
*Academic Department of Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino; and †Division of Gynaecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy.
Int J Gynecol Cancer. 2017 Nov;27(9):1863-1871. doi: 10.1097/IGC.0000000000001097.
The present study assessed the predictive value of age and Modified Frailty Index (mFI) on the management of primary epithelial ovarian cancer (EOC) patients aged 70 years or older (elderly).
A retrospective multicenter study selected elderly EOC patients treated between 2006 and 2014. Treatments were analyzed according to the following age group categories: (1) 70 to 75 years versus (2) older than 75 years, and mFI of less than 4 (low frailty) versus greater than or equal to 4 (high frailty).
Seventy-eight patients were identified (40 in age group 1 and 38 in age group 2). The mFI was greater than or equal to 4 in 23 women. Median age of low frailty and high frailty was not significantly different (75.6 vs 75.3). Comorbidities were equally distributed according to age, whereas diabetes, hypertension, obesity, and chronic renal failure were more frequent in the high-frailty group. Performance status was different only according to mFI. Twenty percent of age group 1 versus 55.3% of age group 2 underwent none or only explorative surgical approach (P = 0.003), whereas surgical approaches were similar in the 2 frailty groups. The rate of postoperative complications was higher in high-frailty patients compared with low-frailty patients (23.5% vs 4.3%; P = 0.03). Chemotherapy was administered to all the patients, a monotherapy regimen to 50% of them. No differences in toxicity were registered, except more hospital recovery in the high-frailty cohort. Median survival time was in favor of younger patients (98 versus 30 months) and less-frailty patients (56 vs 27 months).
Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selected. The pretreatment assessment of frailty through mFI could be suggested in the surgical and medical management.
本研究评估年龄和改良虚弱指数（mFI）对70岁及以上（老年）原发性上皮性卵巢癌（EOC）患者治疗的预测价值。
一项回顾性多中心研究选取了2006年至2014年间接受治疗的老年EOC患者。根据以下年龄组类别分析治疗情况：（1）70至75岁与（2）75岁以上，以及mFI小于4（低虚弱）与大于或等于4（高虚弱）。
共确定78例患者（年龄组1中有40例，年龄组2中有38例）。23名女性的mFI大于或等于4。低虚弱和高虚弱患者的中位年龄无显著差异（75.6岁对75.3岁）。合并症按年龄分布均匀，而糖尿病、高血压、肥胖和慢性肾衰竭在高虚弱组中更为常见。体能状态仅根据mFI有所不同。年龄组1中20%的患者与年龄组2中55.3%的患者未接受任何手术或仅接受探查性手术（P = 0.003），而两个虚弱组的手术方式相似。高虚弱患者的术后并发症发生率高于低虚弱患者（23.5%对4.3%；P = 0.03）。所有患者均接受了化疗，其中50%接受单一疗法。除高虚弱队列的住院恢复时间更长外，未发现毒性差异。中位生存时间有利于年轻患者（98个月对30个月）和虚弱程度较低的患者（56个月对27个月）。
老年EOC患者可以接受充分治疗，但75岁以上的患者如果选择不当可能接受不足的治疗。在手术和医疗管理中，建议通过mFI对虚弱程度进行预处理评估。
