Zhao Yuxi, Zuo Jing, Li Ning, Zheng Rongshou, Yuan Guangwen, Shen Guihua, Wu Lingying
Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.
Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China.
Cancers (Basel). 2022 Jul 27;14(15):3655. doi: 10.3390/cancers14153655.
Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan−Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy.
老年卵巢癌患者预后较差。我们评估了实际年龄和不同治疗特征对老年卵巢癌患者预后的影响；方法：本研究回顾性分析了2011年1月至2019年12月在中国两个国家级中心接受肿瘤细胞减灭术并接受铂类辅助化疗的60岁以上患者。采用倾向评分匹配（PSM，1:1）对合并症和治疗相关因素进行分层。采用Kaplan-Meier法估计原始队列和PSM后队列的无进展生存期（PFS）；结果：共评估了324例患者。年龄≥70岁组比年龄<70岁组更常接受新辅助化疗（62.3%对31.2%，p<0.001），辅助化疗中断更多（31.2%对10.8%，p<0.001），化疗相关毒性更严重（45.6%对34.2%，p = 0.040）。匹配后，年龄<70岁组与年龄≥70岁组的PFS无显著差异（中位PFS分别为12.4个月和11.9个月，p = 0.850）。此外，国际妇产科联盟（FIGO）晚期、非R0肿瘤细胞减灭术和辅助化疗中断均为不良预后因素。血清白蛋白水平<40 g/L（HR = 2.441，p = 0.018）和年龄≥70岁（HR = 2.639，p = 0.008）导致化疗相关毒性更严重。此外，肾功能差（HR = 5.128，p = 0.002）与辅助化疗中断有关；结论：老年患者的实际年龄不能被视为不良预后因素。老年患者可能从R0肿瘤细胞减灭术随后完成化疗中获益最大。术后肾功能差和血清白蛋白水平<40 g/L可能有助于预测辅助化疗的中断。
