Gershenson D M, Mitchell M F, Atkinson N, Silva E G, Burke T W, Morris M, Kavanagh J J, Warner D, Wharton J T
Department of Gynecology, University of Texas M.D. Anderson Cancer Center, Houston, 77030.
Cancer. 1993 Jan 15;71(2 Suppl):638-43. doi: 10.1002/cncr.2820710223.
This study reviews the experience at the University of Texas M.D. Anderson Cancer Center with elderly patients treated for advanced epithelial ovarian cancer with cisplatin-based combination chemotherapy.
From 1978 through 1988, 215 patients with Stage III or IV, Grade 2 or 3 epithelial ovarian cancer were entered onto one of three consecutive trials involving cisplatin-based combination chemotherapy. The treatment plans were as follows: Trial 1: 12 cycles of cisplatin-melphalan (75 patients); Trial 2: 12 cycles of cisplatin-cyclophosphamide (49 patients); and Trial 3: 6 cycles of cisplatin-cyclophosphamide (91 patients). End-points of analysis included the effect of age on other prognostic factors, clinical response rate, surgical response rate, toxicity, progression-free survival, and survival.
Of the entire study group, 57 patients (27%) were 65 years of age and older at diagnosis. There was no effect of age on FIGO stage or histologic grade distribution, but 61% of patients younger than 65 years of age had residual tumors less than or equal to 2 cm compared with only 33% of patients 65 years of age and older (P = 0.00027). There were no differences between the two age groups with respect to response rates, recurrence rate after negative second-look surgery, toxicity, or progression-free survival. Patients in the younger than 65 years of age group, however, had a significantly longer median survival time than those 65 years of age and older (30 versus 19 months, respectively) (P = 0.0038).
This analysis suggests that elderly patients are more likely to begin chemotherapy with bulky residual disease and to have a significantly shorter survival time than their younger counterparts.
本研究回顾了得克萨斯大学MD安德森癌症中心治疗晚期上皮性卵巢癌的老年患者接受以顺铂为基础的联合化疗的经验。
从1978年至1988年，215例Ⅲ期或Ⅳ期、2级或3级上皮性卵巢癌患者进入三项连续试验中的一项，这些试验均采用以顺铂为基础的联合化疗。治疗方案如下：试验1：顺铂-美法仑12个周期（75例患者）；试验2：顺铂-环磷酰胺12个周期（49例患者）；试验3：顺铂-环磷酰胺6个周期（91例患者）。分析的终点包括年龄对其他预后因素的影响、临床缓解率、手术缓解率、毒性、无进展生存期和生存期。
在整个研究组中，57例患者（27%）诊断时年龄在65岁及以上。年龄对国际妇产科联盟（FIGO）分期或组织学分级分布没有影响，但65岁以下患者中有61%的残留肿瘤小于或等于2cm，而65岁及以上患者中只有33%（P = 0.00027）。在缓解率、二次探查手术阴性后的复发率、毒性或无进展生存期方面，两个年龄组之间没有差异。然而，65岁以下年龄组的患者中位生存期明显长于65岁及以上的患者（分别为30个月和19个月）（P = 0.0038）。
该分析表明，老年患者比年轻患者更有可能在有大量残留病灶的情况下开始化疗，并且生存期明显更短。
