Abstract
5058 Background: Approximately one third of women diagnosed with ovarian cancer are 70 years or older. Standard therapy of ovarian cancer including radical cytoreduction and combination chemotherapy has considerable morbidity and information regarding treatment reality in elderly patients with ovarian cancer is very limited. Methods: Patients with primary epithelial ovarian cancer FIGO-stages IIB-IV were prospectively included in 5 European cancer centers. All patients underwent surgery with the intent of maximal cytoreduction and platinum-based chemotherapy. To analyze treatment strategies and outcome in the elderly, patients were subdivided in <70 years and ≥70 years of age and compared regarding clinicopathological variables and prognosis. Results: A total of 275 patients were included and followed for a median of 25 months. Median age of the total cohort was 58 (18-85) years with only 47 patients (17.1%) ≥70 years old. Age itself was not a prognostic factor for progression free survival (PFS) in multivariate analysis. 30-days mortality rate after primary surgery was 3.6% in elderly patients compared to 0.6% in patients <70 years (p=0.153). Surgery was less radical in patients ≥70 (e.g. fewer lymph node dissections p<0.001) and the percentage of patients with residual disease after surgery was higher in elderly (44.7%) compared to younger patients (28.5%) despite similar FIGO stage distribution (p=0.029). Furthermore, elderly received more often mono-chemotherapy (p<0.001). Consequently, outcome was less favorable in patients ≥70 compared to patients <70 years (75% overall survival 16 vs. 28 months; p=0.002 and median PFS 14 vs. 20 months; p=0.182). Conclusions: In this prospective European multicenter study, ovarian cancer patients age 70 and older were treated significantly less radical and had unfavorable outcome compared to younger patients. Specific trials for elderly patients focusing on surgical as well as chemotherapeutic aspects are therefore highly desirable to gain more information in an aging society.
Highlights
One third of women diagnosed with ovarian cancer is 70 years or older
The present analysis investigates the prognostic value of age itself as well as possible confounders impairing the prognosis of elderly patients and further elaborates the need for trials designed for age-related questions
A major concern of surgeons towards elderly patients is the fear of a higher complication and mortality rate as revealed by a retrospective analysis from the Washington State Hospital in 2009 with rising complication rates for abdominal surgery according to age (65–69 years, 14.6%; 70–74 years, 16.1%; 75–79 years, 18.8%; 80–84 years, 19.9%; 85–89 years, 22.6%; p < 0.001) [14]
Summary
One third of women diagnosed with ovarian cancer is 70 years or older. Information on the treatment reality of these elderly patients is limited. Median age at first diagnosis of ovarian cancer is currently 63 years with approximately one third aged 70 or older [2]. Current evidence on the treatment of ovarian cancer in this patient cohort is scarce. Prospective phase III trials concentrating on Irrespective of age, ovarian cancer is still regarded the most lethal gynecological malignancy with a median overall survival of approximately 44 months [4]. Even in advanced tumor stage (FIGO [International Federation of Gynecology and Obstetrics] stage ≥ IIB) the intention of treatment is still curative achieving a rate of approximately 20% of patients without relapse after optimal primary treatment [4]. Optimal treatment thereby consists of the combination of radical cytoreductive surgery (resection of all visible tumor) plus platinum-based combination chemotherapy and is associated with significant morbidity [4]
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