Abstract
Treatment of elderly patients with neoplasia is challenging. Age is a known prognostic factor in ovarian cancer but the optimal treatment of elderly patients has not been determined. We undertook a retrospective analysis to determine clinical practice in advanced-stage ovarian cancer patients older than 70 years of age. Methods: Medical records of women with high-grade serous ovarian cancer, stage III and IV were retrospectively analyzed. Results: A total of 735 patients were identified with a median age of 61.5 years. 22.4% among them were older than 70 years of age at diagnosis. First-line Progression-Free Survival (PFS) and Overall Survival (OS) were significantly worse in elderly patients in comparison to the younger ones [mPFS 11.3 months vs. 14.8 months, (p < 0.001) and mOS 30.2 months vs. 45.6 months (p < 0.001)]. However, elderly patients were characterized by worse ECOG-Performance Status and they were more frequently treated with Neoadjuvant Chemotherapy followed by Interval Debulking Surgery, while often they were more frequently denied debulking surgery compared to patients under 70 years of age. Moreover, elderly patients received more frequently monotherapy with platinum as frontline treatment. In contrast, there was no significant difference in the outcome of the debulking surgery in comparison to the younger patients or the frequency that gBRCA test was performed. Age over 70 years did not retain its significance for either Progression-Free Survival or Overall Survival when adjusted for all other reported prognostic factors. Conclusions: Elderly ovarian cancer patients have a worse prognosis. Comprehensive geriatric assessment should be performed for the optimal treatment of these patients.
Highlights
Ovarian cancer is the second most common gynecological cancer but the most lethal one, causing approximately 13,980 deaths worldwide in 2019 [1]
All patients were divided into two groups based on their age; (a) elderly patients were defined as women over or at 70 years of age with advanced ovarian cancer, (b) younger counterparts were defined as women less than 70 years of age with advanced ovarian cancer
A total of 735 patients with advanced high-grade serous ovarian carcinomas were treated in our institution and were included in the analysis
Summary
Ovarian cancer is the second most common gynecological cancer but the most lethal one, causing approximately 13,980 deaths worldwide in 2019 [1]. Its incidence increases with age, reaching its peak in the seventh decade of life [2]. In women older than 65 years of age, ovarian cancer incidence reaches 50.09 per 100,000, while in younger women its incidence is only 8.83 per 100,000 in the USA [3]. It is estimated that ovarian cancer cases will increase in the following years. Women with ovarian cancer present with advanced diseases, such as FIGO stages III-IV [4]. The optimal initial management of these patients is primary debulking surgery followed by frontline systemic chemotherapy [5]. Patients unfit for surgery due to widely tumor spread will benefit from Neoadjuvant treatment with chemotherapy (NACT)
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