Treatment reality in elderly patients with advanced ovarian cancer: a prospective analysis of the OVCAD consortium

Abstract

Background: Approximately one third of women diagnosed with ovarian cancer is 70 years or older. Information on the treatment reality of these elderly patients is limited.

Methods: 275 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.

Results: Median 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.

Conclusions: Elderly 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.

Figure 1

Prognosis of ovarian cancer patients according to age. Kaplan-Meier curves demonstrating significantly impaired prognosis for elderly ovarian cancer patients regarding progression-free survival (PFS) (A; 12 vs. 20 months, p = 0.022) and overall survival (OS) (B; 30 vs. 64 months, p < 0.001). Statistical comparison by log rank test.

Figure 2

Prognosis of ovarian cancer patients according to age. Kaplan-Meier curves regarding progression-free (PFS) and overall survival (OS) separately analyzed for patients ≥70 years with suboptimal or optimal oncologic treatment opposed to patients younger than 70 years (A; PFS: 11 months vs. 18 months vs. 20 months, p = 0.05; B; OS: 20 months vs. 31 months vs. 64 months, p < 0.001). Statistical comparison by log rank test. optimal = complete tumor resection and platinum-based chemotherapy.