Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA.
Massachusetts General Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 55 Fruit Street, Yawkey 9-E, Boston, MA 02114, USA; Brigham and Women's Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
J Geriatr Oncol. 2018 Sep;9(5):516-519. doi: 10.1016/j.jgo.2018.02.004. Epub 2018 Mar 2.
This study aims to understand the treatment patterns and clinical outcomes of older women with cervical cancer compared to younger women.
Women undergoing care for cervical cancer between 2000 and 2013 at two academic institutions were identified. The cohort of older patients was defined as >65 years old at diagnosis. Patient charts were retrospectively reviewed, and clinical variables were extracted. Fisher's exact tests, logistic regression, and Kaplan-Meier analyses were performed.
From 2000 to 2013 1119 women with cervical cancer were identified. Of these, 191 (17.0%) were >65 years old at the time of diagnosis. Older women were more likely to present with higher stage disease (p < 0.001). Controlling for stage, older women were less likely to undergo surgery during their treatment course (38% versus 70%, p < 0.001) and more likely to undergo radiation (77% versus 52%, p < 0.001), but no more likely to receive chemotherapy (p = 0.34). If they did undergo surgery, older women were less likely to have a pelvic lymph node dissection performed (41% versus 61%, p = 0.04), though the rate of positive pelvic lymph nodes was not different (p = 0.80). Overall survival was decreased in the older cohort (p < 0.001). A multivariate model identified age > 65 (HR 1.76, 95%CI 1.30-2.40), stage (HR 2.77, 95%CI 2.40-3.21), and ever undergoing surgery (HR 0.60, 95%CI 0.44-0.82) as independently associated with overall survival.
Women over age 65 with cervical cancer are less likely to undergo surgical management and were observed to have a decreased overall survival, even when controlling for use of surgery and stage of disease.
本研究旨在了解老年宫颈癌女性与年轻女性相比的治疗模式和临床结局。
在两个学术机构，我们确定了 2000 年至 2013 年期间接受宫颈癌治疗的女性。将老年患者定义为诊断时年龄>65 岁。回顾性查阅患者病历，提取临床变量。采用 Fisher 精确检验、Logistic 回归和 Kaplan-Meier 分析。
2000 年至 2013 年，共确定了 1119 例宫颈癌患者。其中，191 例（17.0%）诊断时年龄>65 岁。老年女性更有可能表现为更高的疾病分期（p<0.001）。控制分期后，老年女性在治疗过程中更不可能接受手术（38%对 70%，p<0.001），更可能接受放疗（77%对 52%，p<0.001），但接受化疗的可能性无差异（p=0.34）。如果接受手术，老年女性接受盆腔淋巴结清扫术的可能性较低（41%对 61%，p=0.04），但盆腔淋巴结阳性率无差异（p=0.80）。老年组的总生存率降低（p<0.001）。多变量模型确定年龄>65 岁（HR 1.76，95%CI 1.30-2.40）、分期（HR 2.77，95%CI 2.40-3.21）和是否接受手术（HR 0.60，95%CI 0.44-0.82）与总生存率独立相关。
年龄>65 岁的宫颈癌女性更不可能接受手术治疗，且即使控制手术和疾病分期的使用，其总生存率也降低。
