Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Department of Obstetrics and Gynecology, Maastricht University Medical Centre, GROW - School for Oncology and Developmental Biology, Maastricht, The Netherlands.
Gynecol Oncol. 2018 May;149(2):270-274. doi: 10.1016/j.ygyno.2018.02.017. Epub 2018 Mar 4.
To provide an overview of treatment strategies for elderly patients with advanced stage epithelial ovarian cancer (EOC) in daily practice, evaluate changes over time and relate this to surgical mortality and survival.
All women diagnosed with advanced stage (FIGO IIB and higher) EOC between 2002 and 2013 were selected from the Netherlands Cancer Registry (n=10,440) and stratified by age, stage and period of diagnosis. Elderly patients were defined as aged ≥70years. Time trends in treatment patterns and postoperative mortality were described by age category and tested using multivariable logistic regression. Relative survival was calculated.
With advancing age, less patients received ((neo-)adjuvant) treatment. Over time, elderly patients were less often treated (OR 2002-2004 versus 2011-2013: 0.73; 95%CI:0.58-0.92). But if treated, more often standard treatment was provided and 30-day postoperative mortality decreased from 4.5% to 1.9% between 2005 and 2007 and 2011-2013. In all age categories treatment shifted from primary surgery towards primary chemotherapy, in patients aged 70-79years combination therapy increased (+5%) between 2002 and 2004 and 2011-2013. Five-year relative survival for patients diagnosed in 2008-2010 aged <70years was 34% compared to 18% for elderly patients.
Large treatment differences exist between younger and elderly patients. Over time, selection of elderly patients eligible for curative surgical treatment may have improved. More elderly patients were treated with neoadjuvant chemotherapy while less patients underwent surgery and simultaneously postoperative mortality decreased. However, the large and increasing number of elderly patients without treatment and the large survival gap suggests opportunities for further improvements in the care for elderly EOC patients.
在日常实践中提供老年晚期上皮性卵巢癌（EOC）患者治疗策略概述，评估随时间的变化，并将其与手术死亡率和生存率相关联。
从荷兰癌症登记处（n=10440）中选择 2002 年至 2013 年间诊断为晚期（FIGO IIB 及以上）EOC 的所有女性，并按年龄、分期和诊断时期进行分层。老年患者定义为年龄≥70 岁。通过年龄组描述治疗模式和术后死亡率的时间趋势，并使用多变量逻辑回归进行检验。计算相对生存率。
随着年龄的增长，接受（新）辅助治疗的患者越来越少。随着时间的推移，老年患者接受治疗的情况越来越少（2002-2004 年与 2011-2013 年的比值比：0.73；95%CI：0.58-0.92）。但如果接受治疗，更常提供标准治疗，并且 30 天术后死亡率从 2005 年至 2007 年和 2011-2013 年降至 1.9%。在所有年龄组中，治疗从主要手术向主要化疗转移，在 70-79 岁的患者中，联合治疗在 2002-2004 年和 2011-2013 年之间增加了（+5%）。2008-2010 年诊断的<70 岁患者的 5 年相对生存率为 34%，而老年患者为 18%。
年轻患者和老年患者之间存在较大的治疗差异。随着时间的推移，适合根治性手术治疗的老年患者的选择可能有所改善。更多的老年患者接受新辅助化疗，而接受手术的患者减少，同时术后死亡率下降。然而，大量未接受治疗的老年患者和巨大的生存差距表明，需要进一步改进对老年 EOC 患者的护理。
