Chambers Laura M, Yao Meng, Morton Molly, Chichura Anna, Costales Anthony B, Horowitz Max, Gruner Morgan F, Rose Peter G, Michener Chad M, DeBernardo Robert
Division of Gynecologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA.
Int J Gynecol Cancer. 2021 Jul;31(7):1021-1030. doi: 10.1136/ijgc-2021-002622. Epub 2021 May 18.
To evaluate perioperative outcomes in elderly versus non-elderly women with advanced or recurrent epithelial ovarian cancer undergoing surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).
A single-institution prospective registry was analyzed for women with ovarian cancer who underwent surgery with HIPEC from January 2014 to December 2020. Elderly age was defined as ≥65 years at surgery. Complications were defined according to the Accordion scale. Univariate and multivariable analysis was used to compare progression-free survival and overall survival.
Of 127 women who underwent surgery with HIPEC, 33.1% (n=42) were ≥65 and 17.3% (n=22) were ≥70 years old. The median age for non-elderly and elderly patients were 55.7±8.3 versus 72.0±5.4 years, respectively (p<0.001). The majority of non-elderly versus elderly patients underwent HIPEC at the time of interval cytoreductive surgery following neoadjuvant chemotherapy (52.9% vs 73.8%, p=0.024). There were no differences in moderate (15.3% vs 26.2%) or severe postoperative complications (10.6% vs 11.9%, p=0.08), acute kidney injury (7.1% vs 16.7%, p=0.12), and length of stay (5.0 vs 5.0 days, p=0.56) for non-elderly versus elderly patients. With a median follow-up of 20 months (95% CI 9.1 to 32.7 months), there was no difference in progression-free survival (18.8 vs 15.7 months, p=0.75) or overall survival (61.6 months vs not estimable, p=0.72) for non-elderly versus elderly patients. Comparing patients 65-69 versus ≥70 years, progression-free survival (33.0 vs 12.5 months, p=0.002) was significantly improved in patients aged 65-69, without difference in overall survival (not estimable vs 36.0 months, p=0.91). On multivariable analysis, age ≥65 did not impact progression-free survival (p=0.74).
In this prospective registry of women with ovarian cancer, perioperative morbidity is not increased for non-elderly versus elderly patients following surgery with HIPEC. While age should not exclude patients from surgery with HIPEC, additional research is needed regarding oncologic benefits in elderly women.
评估接受热灌注化疗（HIPEC）手术的老年与非老年晚期或复发性上皮性卵巢癌女性患者的围手术期结局。
对2014年1月至2020年12月期间接受HIPEC手术的卵巢癌女性患者进行单机构前瞻性登记分析。老年定义为手术时年龄≥65岁。并发症根据手风琴量表定义。采用单因素和多因素分析比较无进展生存期和总生存期。
在127例接受HIPEC手术的女性患者中，33.1%（n = 42）年龄≥65岁，17.3%（n = 22）年龄≥70岁。非老年和老年患者的中位年龄分别为55.7±8.3岁和72.0±5.4岁（p<0.001）。大多数非老年与老年患者在新辅助化疗后的间隔减瘤手术时接受HIPEC（52.9%对73.8%，p = 0.024）。非老年与老年患者在中度（15.3%对26.2%）或重度术后并发症（10.6%对11.9%，p = 0.08）、急性肾损伤（7.1%对16.7%，p = 0.12）以及住院时间（5.0天对5.0天，p = 0.56）方面无差异。中位随访20个月（95%CI 9.1至32.7个月），非老年与老年患者在无进展生存期（18.8个月对15.7个月，p = 0.75）或总生存期（61.6个月对无法估计，p = 0.72）方面无差异。比较65 - 69岁与≥70岁的患者，65 - 69岁患者的无进展生存期（33.0个月对12.5个月，p = 0.002）显著改善，总生存期无差异（无法估计对36.0个月，p = 0.91）。多因素分析显示，年龄≥65岁不影响无进展生存期（p = 0.74）。
在这个卵巢癌女性患者的前瞻性登记研究中，非老年与老年患者接受HIPEC手术后围手术期发病率并未增加。虽然年龄不应成为患者接受HIPEC手术的排除因素，但仍需要对老年女性患者的肿瘤学获益进行更多研究。
