Aging affects regrowth of stealthperitoneal dissemination of advanced ovarian cancer: a multicenter retrospective cohort study

Abstract

Ovarian cancer (OvCa) is one of the most lethal gynecological malignancies, and most patients are diagnosed at advanced stage with peritoneal dissemination. Although age at diagnosis is considered an independent prognostic factor, its impact on peritoneal recurrence after combined cytoreductive surgery and chemotherapy is not clear. The objective of this study was to investigate the impact of aging on peritoneal recurrence from stealth dissemination and gain insight of the pathophysiology of OvCa in elderly patients. A total of 243 patients with pT2b-pT3 epithelial ovarian who achieved complete surgery, no-residual tumor at first surgery, were selected to be analyzed the risk of peritoneal seeding and recurrence. We found that age over 65 years was independently associated with an increased risk of peritoneum-specific (PS) recurrence (. Furthermore, pT3 stages and positive ascites cytology also worsen the PS-relapse-free survival. Collectively, our findings suggest that age, especially over 65 years, predicts reduced peritoneum-specific tumor recurrence in patients with advanced ovarian cancer after complete cytoreduction surgery, particularly those with pT3 tumors and positive ascites cytology.

Keywords: Aging; Ovarian cancer; Peritoneal dissemination; Recurrence.

Figure 1

(A–D) Kaplan–Meier curves for peritoneum-specific recurrence-free (A,B), recurrence-free (C), and overall survival (D) in epithelial ovarian cancer patients with each age category (under 45, 40 to 49, 50 to 64, and 65 years or older). P-values were estimated by log rank test.

Figure 2

Spline models of hazard ratio regarding peritoneum-specific recurrence-free (A) and recurrence-free survival (B) for age, adjusted by pT stage, pN stage, histology, hysterectomy, CA-125 level, and result of cytology.

Figure 3

Estimation of the hazard ratio of peritoneum-specific recurrence-free (A) and recurrence-free survival (B) with 95% confidence interval for age category of 65 years or older in each subgroup.

Figure 4

Schematic image of the impact of aging on regrowth of stealth peritoneal dissemination.