Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Gynecology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:174-179. doi: 10.1016/j.ejogrb.2018.06.032. Epub 2018 Jun 18.
With the population aging, development of safe and effective treatments for elderly patients with cancer is needed. Although old age is considered a poor prognostic factor, this is not only because of the patient's disease condition or response to treatment, but also because of treatment strategy and intensity. The purpose of this study was to clarify the influence of age on treatment and prognosis in patients with cervical cancer.
Women with stage Ib-IV cervical cancer treated at our institution between 1997 and 2014 were retrospectively analyzed. Patients were stratified by age into groups for analysis, <65 years and ≥65 years. Categorical variables were compared using chi-squared and Fisher's exact tests. Survival analyses were performed using the Kaplan-Meier method, and comparisons were made using the log-rank test. Subsequently, Cox proportional hazards models were developed to find independent prognostic factors.
Of 959 patients included in our study, 247 were ≥65 and 712 were <65 years of age. Elderly patients tended to be at a more advanced stage than younger patients (p < 0.001). Elderly patients more commonly had comorbidities. More received standard treatment in the younger patient group at any disease stage than in the elderly patient group (p < 0.001). Similar rates of adverse effects caused by surgery or radiotherapy were seen in patients from both groups. Although overall survival was statistically shorter in elderly patients (74.7 vs. 57.1%, p < 0.001), there was no significant difference in disease-specific survival for patients treated only with standard treatment. In multivariate analyses, clinical stage, histological type, treatment intensity, and primary surgery remained independent prognostic factors. Age was not an independent prognostic factor.
The influence of age on prognosis in patients with cervical cancer was less than we expected. Elderly patients might have better outcomes depending on the type of standard treatment they receive. The appropriate modality and intensity of treatment should be based on the patient's general condition and background.
随着人口老龄化，需要开发安全有效的治疗方法来治疗老年癌症患者。尽管年龄较大被认为是预后不良的因素，但这不仅是因为患者的疾病状况或对治疗的反应，还因为治疗策略和强度。本研究的目的是阐明年龄对宫颈癌患者治疗和预后的影响。
回顾性分析 1997 年至 2014 年在我院治疗的 I b-IV 期宫颈癌患者。根据年龄将患者分为两组进行分析，<65 岁和≥65 岁。使用卡方检验和 Fisher 精确检验比较分类变量。使用 Kaplan-Meier 方法进行生存分析，并使用对数秩检验进行比较。随后，建立 Cox 比例风险模型以寻找独立的预后因素。
本研究共纳入 959 例患者，其中 247 例≥65 岁，712 例<65 岁。老年患者比年轻患者更倾向于处于晚期（p<0.001）。老年患者更常患有合并症。在任何疾病阶段，年轻患者组接受标准治疗的比例均高于老年患者组（p<0.001）。两组患者手术或放疗引起的不良反应发生率相似。尽管老年患者的总体生存率统计学上较短（74.7% vs. 57.1%，p<0.001），但仅接受标准治疗的患者的疾病特异性生存率无显著差异。多变量分析显示，临床分期、组织学类型、治疗强度和初次手术仍然是独立的预后因素。年龄不是独立的预后因素。
年龄对宫颈癌患者预后的影响小于预期。老年患者可能根据接受的标准治疗类型获得更好的结果。适当的治疗方式和强度应基于患者的一般状况和背景。
