Dion Ludivine, Mimoun Camille, Nyangoh Timoh Krystel, Bendifallah Sofiane, Bricou Alexandre, Collinet Pierre, Touboul Cyril, Ouldamer Lobna, Azaïs Henri, Dabi Yohann, Akladios Cherif, Canlorbe Geoffroy, Bolze Pierre-Adrien, Costaz Hélène, Mezzadri Mathieu, Gauthier Tristan, Kridelka Frederik, Chauvet Pauline, Bourdel Nicolas, Koskas Martin, Carcopino Xavier, Raimond Emilie, Graesslin Olivier, Lecointre Lise, Ballester Marcos, Levêque Jean, Huchon Cyrille, Lavoué Vincent
Department of Gynecology, Rennes University Hospital, 35000 Rennes, France.
IRSET, Equipe 8, INSERM University 1085, 35000 Rennes, France.
J Clin Med. 2020 May 4;9(5):1339. doi: 10.3390/jcm9051339.
Elderly and/or frail women with ovarian cancer are often undertreated. The aim of the study is to compare the effects of age and frailty on surgical approaches, postoperative complications, and prognosis in elderly women with ovarian cancer.
A retrospective multicenter study of women ≥70 years were treated for ovarian cancer at seven French university hospitals between 2007 and 2015.
Of the 1119 women treated for ovarian cancer during the study period, 147 were ≥70 years and had complete data. Of these women, 65 were aged 70-74 years, and 82 were aged ≥75 years. Overall, 77% of the younger women (49/65) received optimal treatment compared with 51% (40/82) of the older women ( = 0.018). Women ≥75 years underwent fewer bowel resections (32% vs. 67%, < 0.001) and experienced fewer postoperative complications (22.6% vs. 38.9%, < 0.001); 53.2% of the women in this age group were treated by primary surgery or surgery only. These women also received more chemotherapy with platinum only (15% [9/56] vs. 2% [1/57], = 0.007) and less bevacizumab (9% [5/56] vs. 32% [18/57], = 0.003). Patients with greater frailty (a modified Charlson Comorbidity Index [mCCI] score >3) had a five-year survival rate of 30% versus 62% for those with a score ≤3 ( < 0.001).
Surgeons modify their approach to treating ovarian cancer in women ≥75 years probably to reduce immediate postoperative complications. The prognosis is significantly worse in patients with greater frailty. Improvements to the sequence of treatments administered, with priority given to neoadjuvant chemotherapy in patients with greater frailty, could help increase the number of women who receive optimal treatment and improve their prognosis.
老年和/或体弱的卵巢癌女性患者常常接受不足的治疗。本研究的目的是比较年龄和体弱对老年卵巢癌女性手术方式、术后并发症及预后的影响。
对2007年至2015年期间在法国七家大学医院接受卵巢癌治疗的≥70岁女性进行一项回顾性多中心研究。
在研究期间接受卵巢癌治疗的1119名女性中，147名≥70岁且有完整数据。在这些女性中，65名年龄在70 - 74岁，82名年龄≥75岁。总体而言，较年轻女性中有77%（49/65）接受了最佳治疗，而老年女性中这一比例为51%（40/82）（P = 0.018）。≥75岁的女性接受肠切除术的比例较低（32%对67%，P < 0.001），术后并发症也较少（22.6%对38.9%，P < 0.001）；该年龄组53.2%的女性接受了初次手术或仅手术治疗。这些女性接受单纯铂类化疗的比例也更高（15% [9/56]对2% [1/57]，P = 0.007），而接受贝伐单抗治疗的比例更低（9% [5/56]对32% [18/57]，P = 0.003）。体弱程度较高（改良Charlson合并症指数[mCCI]评分>3）的患者五年生存率为30%，而评分≤3的患者为62%（P < 0.001）。
外科医生可能会改变对≥75岁女性卵巢癌的治疗方式，以减少术后即刻并发症。体弱程度较高的患者预后明显更差。改进治疗顺序，优先对体弱程度较高的患者进行新辅助化疗，可能有助于增加接受最佳治疗的女性数量并改善其预后。
