Prognostic factors for types I and II epithelial ovarian cancer in the elderly

Abstract

Purpose: No consensus exists on whether age is independently associated with poor prognosis in epithelial ovarian cancer (EOC). This study aimed to examine the prognostic factors of EOC in elderly patients. Materials and Methods:A total of 665 EOC patients from Jiangsu Institute of Cancer Research (JICR, People’s Republic of China) were retrospectively analyzed between 1996 and 2015. For validation, 990 cases who consulted at MD Anderson Cancer Center (MDACC, USA) from 1990 to 2011 were recruited. The associations between survival durations and covariates were assessed by Cox proportional hazards model and log-rank test. Results: Histological type II (p = 0.01) and suboptimal surgery outcome (p = 0.00) were more common in the elderly (age ≥ 70 years) patients with EOC than in younger patients from JICR. The International Federation of Gynecology and Obstetrics (FIGO) stage, histological type, and optimal surgery were independently associated with overall survival (OS; p = 0.00, p = 0.03, and p = 0.00, respectively) and progression-free survival (PFS; p = 0.00, p = 0.02, and p = 0.00, respectively) in the EOC patients. Both OS and PFS were lower in the elderly patients with type I EOC than in the younger cases (136.5 months vs. 191.8 months at p = 0.00 and 35.5 months vs. 75.1 months at p = 0.01, respectively). The OS and PFS of the elderly patients were poorer than those of the younger cases with type II EOC (38.4 months vs. 42.3 months at p = 0.00 and 14.9 months vs. 16.8 months, p = 0.04, respectively). In type II ovarian cancer patients who achieved optimal debulking, the median OS and PFS durations of younger patients remained longer than those of elderly patients (50.2 months vs. 68.0 months, p = 0.00 and 14.9 months vs. 19.2 months, p = 0.01, respectively). Conclusions: Compared with young patients, elderly EOC more commonly presented with an aggressive histological type and poor performance status and was more frequently undertreated. Advanced age was independently associated with poor prognosis in EOC, even after the influence of histological type and surgical outcome was eliminated.