Alberts D S, Dahlberg S, Green S J, Garcia D, Hannigan E V, O'Toole R, Stock-Novack D, Surwit E A, Malviya V K, Jolles C J
Division of Internal Medicine, University of Arizona Cancer Center, Tucson.
Cancer. 1993 Jan 15;71(2 Suppl):618-27. doi: 10.1002/cncr.2820710220.
The purpose of this study was to evaluate the effect of age (i.e., less than 65 years or 65 years of age and older) on survival in a recently completed phase III Southwest Oncology Group study in ovarian cancer patients.
Multivariate and univariate regression analyses were used to identify independent prognostic factors of survival in 342 patients with previously untreated Stage III (suboptimal) or Stage IV ovarian cancer who participated in a randomized, phase III study of intravenous (I.V.) carboplatin 300 mg/m2 plus I.V. cyclophosphamide 600 mg/m2 versus I.V. cisplatin 100 mg/m2 plus I.V. cyclophosphamide 600 mg/m2 every 4 weeks for six courses.
Multivariate regression analysis showed the following variables to be independent prognostic factors of survival: age (P = 0.04); performance status (P = 0.004); disease stage (P = 0.03); and race (P = 0.05). Patients under 65 years of age survived significantly longer than those 65 years or older, especially patients with a performance status of 2. Patients with a baseline performance status of 0-1 survived longer than patients with a performance status of 2, and Stage III patients longer than those with Stage IV disease. An unexpected finding was that white patients survived significantly longer than black patients, regardless of age, performance status, or stage of disease. Carboplatin-cyclophosphamide-treated patients experienced similar survival and significantly less nausea and emesis, renal toxicity, hearing loss, tinnitus, neuromuscular toxicities, and alopecia.
Ovarian cancer patients with advanced disease who are 65 years of age or older and/or with a performance status of 2 have significantly decreased survival compared to their younger and/or less debilitated counterparts. Carboplatin-cyclophosphamide is the recommended treatment (rather than cisplatin-cyclophosphamide), especially for older or debilitated patients because it is associated with less toxicity and similar survival.
本研究旨在评估年龄（即小于65岁或65岁及以上）对近期完成的西南肿瘤协作组卵巢癌患者III期研究中生存率的影响。
采用多变量和单变量回归分析，确定342例先前未经治疗的III期（次优）或IV期卵巢癌患者的独立生存预后因素，这些患者参与了一项随机III期研究，比较静脉注射卡铂300mg/m²加静脉注射环磷酰胺600mg/m²与静脉注射顺铂100mg/m²加静脉注射环磷酰胺600mg/m²，每4周一次，共六个疗程。
多变量回归分析显示以下变量为生存的独立预后因素：年龄（P = 0.04）；体能状态（P = 0.004）；疾病分期（P = 0.03）；以及种族（P = 0.05）。65岁以下患者的生存期明显长于65岁及以上患者，尤其是体能状态为2的患者。基线体能状态为0 - 1的患者比体能状态为2的患者生存期长，III期患者比IV期患者生存期长。一个意外发现是，无论年龄、体能状态或疾病分期如何，白人患者的生存期明显长于黑人患者。接受卡铂 - 环磷酰胺治疗的患者生存期相似，且恶心呕吐、肾毒性、听力丧失、耳鸣、神经肌肉毒性和脱发明显较少。
与年轻和/或身体状况较好的晚期卵巢癌患者相比，65岁及以上和/或体能状态为2的患者生存率显著降低。推荐使用卡铂 - 环磷酰胺（而非顺铂 - 环磷酰胺）进行治疗，尤其是对于老年或身体虚弱的患者，因为其毒性较小且生存期相似。
