Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study

Anne Weng Ekmann-Gade,Claus Kim Høgdall,Lene Seibæk,Mette Calundann Noer,Carsten Lindberg Fagö-Olsen,Tine Henrichsen Schnack

doi:10.1016/j.ygyno.2021.10.081

Anne Weng Ekmann-Gade, Claus Kim Høgdall + Show 4 more

Open Access

https://doi.org/10.1016/j.ygyno.2021.10.081

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Abstract

ObjectiveTo examine clinical trends in Denmark for younger and older epithelial ovarian cancer (EOC) patients, focusing on incidence, treatment, and survival changes. MethodsWe included a nationwide cohort diagnosed with EOC from 2005 to 2018. We described age-standardized incidence, surgical patterns, residual disease trends, and cancer-specific survival stratified by age (<70 and ≥ 70 years), stage, and period (2005–09, 2010–13, 2014–18). ResultsWe included 7522 patients. The incidence decreased from 16.3 (2005) to 11.4 (2018) per 100,000 woman-years, driven by the younger cohort. While the proportion of patients with stage IIIC-IV disease undergoing primary debulking surgery (PDS) decreased, the proportion of patients having interval debulking surgery (IDS) and no debulking surgery increased significantly. In 2014–18, 36% and 24% had PDS for younger and older patients, respectively, compared to 72% and 62% in 2005–09. In both age cohorts, the proportion of patients debulked to no residual disease increased significantly among patients with stage IIIC-IV and in the total cohort. Two-year cancer-specific survival increased from 75% (2005–09) to 84% (2014–18) for younger patients and from 53% to 66% for older patients. After adjusting for potential confounders, age ≥ 70 was associated with a 1.4-fold increased risk of cancer-specific death (95% confidence interval: 1.2,1.5). ConclusionsThe proportion of patients with advanced EOC not undergoing PDS or IDS increased significantly. During the same period, patients debulked to no residual disease, and cancer-specific survival increased. However, a survival gap in favor of the younger patients remains after adjusting for potential confounders.

Highlights

We observed a significant decrease in the agestandardized incidence rate from 14.3 per 100,000 woman-years in 2005 to 9.0 per 100,000 woman-years in 2018 (APC = −2.8; 95% confidence intervals (CI): −3.6, −2.1)
The proportion of patients debulked to no residual disease after primary debulking surgery (PDS) or interval debulking surgery (IDS) increased; we found the same trend in the total cohort of patients with stage IIIC-IV
Our results show a significant increase in the proportion of patients debulked to no residual disease, and during the same period, cancerspecific survival increased

Summary

Methods

We included a nationwide cohort diagnosed with EOC from 2005 to 2018. In this nationwide cohort study, we included all patients in Denmark aged 18 years or older diagnosed with EOC (including primary cancer in the ovaries, fallopian tubes, or peritoneum) between January 1, 2005, and December 31, 2018. Patients were identified in the Danish Gynecological Cancer Database (DGCD). The DGCD is a nationwide multidisciplinary database containing detailed information about gynecological malignancies [6]. The DGCD has linked annually with the Danish Register of Causes of Death and the National Patient Registry to enhance the completeness of registration. The Danish Register of Causes of Death collects information regarding all deaths in Denmark. Data originates from mandatory death certificates, including date and cause of death, coded according to the ICD-10 [7]. Data on whether the patients had received chemotherapy (yes/no) in the frontline setting was added from the National Patient Registry

Results

Discussion

Conclusion