Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY, USA.
Gynecol Oncol. 2021 Jun;161(3):693-699. doi: 10.1016/j.ygyno.2021.03.008. Epub 2021 Mar 31.
Older women have a worse prognosis with advanced epithelial ovarian cancer (EOC) and comorbidities likely contribute to poor outcomes. We sought to identify comorbid conditions and treatment-related factors in older women.
A retrospective chart review identified 351 patients who underwent cytoreductive surgery (CRS). 100/351 (28.5%) were ≥ 70 years old. Demographic and clinicopathologic information was collected. Crude progression-free (PFS) and overall survival (OS) estimates were calculated using Kaplan-Meier method. Cox proportional hazards regression model was used to estimate hazard ratios and adjustments for confounders.
Study subjects ≥70 years old had significantly: higher Cumulative Illness Rating Scale-Geriatric (CIRS-G) score (5.9 vs 4.3; p = 0.0001), less completion of adjuvant chemotherapy (24% vs 15.1%; p = 0.049), less intraperitoneal (IP) therapy (18.2% vs 35.5%; p = 0.002), less clinical trial participation (16% vs 26.3%; p = 0.040), decreased platinum sensitivity (60% vs 73.7%; p = 0.012) and lacked BRCA mutations (0% vs 12%; p = 0.0006). They were less likely to have optimal CRS (75% vs 86.9%; p = 0.007) with same surgical complexity (p = 0.89). Patients ≥70 had significantly worse PFS and OS. In a multivariate analysis, better OS was associated with younger age (<70 years old), any IP therapy, completion of adjuvant chemotherapy, and platinum sensitivity.
The older cohort had worse CIRS-G scores (5.9 vs 4.3; p = 0.0001), but no strong associations between comorbidities and treatment characteristics, but less optimal CRS rates (75% vs 86.9%; p = 0.007) with similar surgical complexity and less platinum sensitivity. Our results show comorbid conditions in older patients with advanced EOC may have less impact than tumor biology.
患有晚期上皮性卵巢癌（EOC）的老年女性预后更差，合并症可能导致不良结局。我们试图确定老年女性的合并症和与治疗相关的因素。
回顾性病历分析确定了 351 名接受细胞减灭术（CRS）的患者。其中 100/351（28.5%）年龄≥70 岁。收集人口统计学和临床病理学信息。使用 Kaplan-Meier 法计算无进展生存期（PFS）和总生存期（OS）的估计值。使用 Cox 比例风险回归模型估计风险比并进行混杂因素调整。
年龄≥70 岁的研究对象的累积疾病严重程度评分-老年（CIRS-G）评分显著更高（5.9 与 4.3；p=0.0001），辅助化疗完成率更低（24%与 15.1%；p=0.049），腹腔内（IP）治疗更少（18.2%与 35.5%；p=0.002），临床试验参与率更低（16%与 26.3%；p=0.040），铂类敏感性降低（60%与 73.7%；p=0.012），缺乏 BRCA 突变（0%与 12%；p=0.0006）。他们不太可能接受最佳的 CRS（75%与 86.9%；p=0.007），但手术复杂性相同（p=0.89）。年龄≥70 岁的患者 PFS 和 OS 明显更差。在多变量分析中，更好的 OS 与年龄较小（<70 岁）、任何 IP 治疗、辅助化疗完成和铂类敏感性有关。
老年组的 CIRS-G 评分更高（5.9 与 4.3；p=0.0001），但合并症与治疗特征之间没有强烈关联，但 CRS 率较低（75%与 86.9%；p=0.007），手术复杂性相似，铂类敏感性较低。我们的研究结果表明，晚期上皮性卵巢癌老年患者的合并症可能比肿瘤生物学的影响更小。
