Treatment outcomes and predictive factors in patients ≥70 years old with advanced ovarian cancer

Abstract

Objective To evaluate treatment outcomes, survival, and predictive factors in patients ≥70 with advanced epithelial ovarian cancer (AEOC). Methods A retrospective single institution cohort study of women ≥70 with Stage III–IV AEOC between 2010 and 2018. Patients had either primary cytoreductive surgery (PCS), neoadjuvant chemotherapy (NACT) with interval cytoreductive surgery (ICS), chemotherapy alone, or no treatment. Demographics, surgical outcome, complications, and survival outcome were compared between groups. Results Among 248 patients, 69 (27.7%) underwent PCS, 99 (39.9%) had ICS, 56 (22.5%) had chemotherapy alone. Twenty‐four (9.6%) remained untreated. Optimal cytoreduction (≤1 cm) was achieved in 72.4% of PCS and 77.8% of NACT/ICS (p = 0.34), without difference in grade ≥3 postoperative complications (15.9% vs. 9.1%, p = 0.37). Progression‐free survival (PFS) was 23.5 months in PCS and 15.0 months in ICS patients (hazard ratio [HR]: 1.4, p = 0.041). Patients in the surgical arms, PCS or ICS, had better 2‐year overall survival (OS) compared to chemotherapy alone (79%, 68%, 41%, respectively, HR: 3.58, p < 0.001). In a subgroup analysis, patients ≥80 had improved 2‐year OS when treated with NACT compared to PCS (82% vs. 57%) and a trend toward improved PFS. Age, stage, and CA‐125 were determinants of undergoing PCS. Conclusion In patients ≥70 with AEOC, surgery should not be deferred based on age alone. Fit, well selected patients ≥70 can benefit from PCS, while patients ≥80 might benefit from NACT over PCS.

Integrated prediction model of patient factors, resectability scores and surgical complexity to predict cytoreductive outcome and guide treatment plan in advanced ovarian cancer

“…Based on our cut-offs, all patients aged over 80 would be automatically triaged to NACT which may be a limitation of our model in patients with high performance and nutritional status that have low disease burden that may benefit from PCS. Nonetheless, these findings are consistent with our previous study whereby patients ≥80 had better PFS and OS with NACT albeit low sub-sample size and consistent with the literature including the Mayo Clinic Algorithm where most patients ≥80 are treated with NACT [17,[27][28][29]. In addition, based on the experience of MSKCC, we have added a step for Stage IV unresectable patients and have found this model to better triage patients to NACT , including 3 patients who had suboptimal cytoreduction, thus increasing specificity of our model.…”

“…A patient factor score step in our algorithm was added to reflect our patient population; based on our group's previous study on treatment outcomes in patients >70 [27], an age cut-off of 60, which is used in the SRS, was not sufficient to be deemed a non-surgical candidate therefore we have created age groups and combined them with other factors including albumin and ECOG. Based on our cut-offs, all patients aged over 80 would be automatically triaged to NACT which may be a limitation of our model in patients with high performance and nutritional status that have low disease burden that may benefit from PCS.…”

Surgery in Advanced Ovary Cancer: Primary versus Interval Cytoreduction

“…Additional studies assessing age have been performed with conflicting age cutoffs for offering NACT as a reasonable alternative including age >75 or >80 years as the lower limit of age to offer NACT over PDS [221,222]. In some studies, even some patients >80 years old do not experience a difference in complications with PDS compared to younger patients [223].…”

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

“…Cytoreduction with no visible tumor has long been recognized as one of the most important prognostic factors for patients with OC [ 23 , 24 , 25 ]. Piedimonte et al retrospectively analyzed 248 women aged ≥70 years to evaluate the significance of R0 cytoreduction on prognosis [ 26 ]. Sixty-eight patients received R0 cytoreduction in the PDS and IDS groups.…”