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

Abstract

Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan−Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy.

Keywords: adjuvant chemotherapy; albumin; older patient; ovarian cancer; prognosis.

Figure 1

The prognostic analysis of age on PFS. (A) Progression-free Survival in the original cohort, (B) Progression-free Survival in the cohort after PSM.

Figure 2

Multivariate analysis of PFS in the original cohort and the cohort after PSM. (A) Multivariate analysis of progression-free survival in the original cohort, (B) Multivariate analysis of progression-free survival in the cohort after PSM. (The characteristics with p < 0.05 are shown in red, while other characteristics with p ≥ 0.05 are shown in blue.).

Figure 3

Prognostic analysis of different treatment patterns in both cohorts. (A) Progression-free Survival in the original cohort, (B) Progression-free Survival in the cohort after PSM. (Group A: Patients received R0 cytoreduction followed by completion of adjuvant chemotherapy. Group B: Patients received R0 cytoreduction followed by discontinuation of adjuvant chemotherapy. Group C: Patients received non-R0 cytoreduction followed by completion of adjuvant chemotherapy. Group D: Patients received non-R0 followed by discontinuation of adjuvant chemotherapy.).

Figure 4

Prognostic analysis of completion of adjuvant chemotherapy on PFS. (A) Progression-free survival in the original cohort, (B) Progression-free survival in the Age ≥ 70 group, (C) Progression-free survival in the Age < 70 group.