Thigpen T, Brady M F, Omura G A, Creasman W T, McGuire W P, Hoskins W J, Williams S
Department of Medicine, University of Mississippi School of Medicine, Jackson.
Cancer. 1993 Jan 15;71(2 Suppl):606-14. doi: 10.1002/cncr.2820710218.
The Gynecologic Oncology Group (GOG) has completed six major randomized trials in advanced ovarian carcinoma over the 15-year period between 1976 and 1990. This large database of 2123 patients provides a well-studied patient population with which to examine the importance of age as a prognostic factor.
The 2123 patients studied in the six GOG trials were analyzed as a group to determine important prognostic factors. Further analyses were then conducted to examine outcome by decade of life from younger than 40 years old to 70 years old and older and to evaluate the interaction of age with other significant prognostic variables.
Three major prognostic factors were identified as exerting an influence on patient outcome in the overall patient population: age, volume of residual disease, and performance status. With regard to the effect of age, patients older than 69 years of age exhibited significantly poorer survival than those younger, even after correction for stage, residual disease, and performance status. This was not altered by variations in drugs, doses, and schedules; but there was no evidence that older patients tolerated intensive schedules less well than younger patients.
Two practical conclusions result from this analysis. First, there is no evidence that modification of the drugs and schedules that make up the regimens used can overcome the adverse effect of older age. Second, age does not adversely affect the dose intensity that can be achieved; hence, age in itself is not reason to withhold or attenuate intensive chemotherapy, particularly in light of the fact that older patients have a poorer prognosis.
妇科肿瘤学组（GOG）在1976年至1990年的15年期间完成了六项针对晚期卵巢癌的大型随机试验。这个包含2123名患者的大型数据库提供了一个经过充分研究的患者群体，可用于研究年龄作为预后因素的重要性。
对GOG六项试验中研究的2123名患者作为一个整体进行分析，以确定重要的预后因素。然后进一步分析按年龄十年分组（从40岁以下到70岁及以上）的结局，并评估年龄与其他重要预后变量的相互作用。
确定了三个对总体患者群体的预后有影响的主要预后因素：年龄、残留病灶体积和体能状态。关于年龄的影响，即使在对分期、残留病灶和体能状态进行校正后，69岁以上的患者生存率仍显著低于年轻患者。这不受药物、剂量和方案变化的影响；但没有证据表明老年患者对强化方案的耐受性比年轻患者差。
该分析得出两个实际结论。第一，没有证据表明组成治疗方案的药物和方案的调整能够克服老年的不利影响。第二，年龄不会对可达到的剂量强度产生不利影响；因此，年龄本身并不是拒绝或减弱强化化疗的理由，特别是考虑到老年患者预后较差这一事实。
