Abstract
BackgroundApproximately one third of women diagnosed with ovarian cancer is 70 years or older. Information on the treatment reality of these elderly patients is limited.Methods275 patients with primary epithelial ovarian cancer FIGO stage II-IV undergoing cytoreductive surgery and platinum-based chemotherapy were prospectively included in this European multicenter study. Patients <70 and ≥70 years were compared regarding clinicopathological variables and prognosis.ResultsMedian age was 58 years (18–85); 47 patients (17.1%) were 70 years or older. The postoperative 60-day-mortality rate was 2.1% for elderly and 0.4% for younger patients (p < 0.001). Elderly patients were less likely to receive optimal therapy (no residual disease after surgery and platinum combination chemotherapy) compared to patients <70 years (40.4% vs. 70.1%, p < 0.001) and their outcome was less favorable regarding median PFS (12 vs. 20 months, p = 0.022) and OS (30 vs. 64 months, p < 0.001). However, in multivariate analysis age itself was not a prognostic factor for PFS while the ECOG performance status had prognostic significance in elderly patients.ConclusionsElderly patients with ovarian cancer are often treated less radically. Their outcome is impaired despite no consistent prognostic effect of age itself. Biological age and functional status should be considered before individualized treatment plans are defined.
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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