Chemotherapy alone for patients 75 years and older with epithelial ovarian cancer—is interval cytoreductive surgery still needed? - 28/01/20
Abstract |
Background |
Patients ≥75 years old with ovarian cancer experience high perioperative morbidity, but recruitment into prospective trials to assess the role of surgery continues to be challenging.
Objective |
To compare overall survival for patients ≥75 years old with ovarian cancer after chemotherapy alone vs neoadjuvant chemotherapy with interval cytoreductive surgery.
Study Design |
Data were extracted from the National Cancer Data Base from 2004 to 2014. Kaplan–Meier and Cox proportional hazards models were used for statistical analyses.
Results |
Of 1661 patients (median age: 79 years), most were white (88%) and had stage III–IV disease (95%), and 51% had serous histology. Of those who did not receive primary surgery, 58% had chemotherapy alone and the remainder had neoadjuvant chemotherapy with interval cytoreductive surgery. The use of neoadjuvant chemotherapy with interval cytoreductive surgery increased from 28% to 50% in years 2004–2007 to 2012–2014 (P<.001). Compared with neoadjuvant chemotherapy with interval cytoreductive surgery, chemotherapy-only patients were older (80 vs 78 years; P<.001) and had more advanced stage disease (98% vs 91%; P<.001). The 5-year overall survival of the entire study group was 14%; those who underwent neoadjuvant chemotherapy with interval cytoreductive surgery had overall survival of 25% compared with only 7% in chemotherapy alone group (P<.001). In multivariable analysis, neoadjuvant chemotherapy with interval cytoreductive surgery (hazard ratio, 0.44; 95% confidence interval, 0.36–0.54; P<.001) was an independent predictor for improved survival. Older (80–84 years) age (hazard ratio, 1.35; 95% confidence interval, 1.12–1.63; P=.002), advanced (stage III–IV) disease (hazard ratio; 2.06, 95% confidence interval, 1.37–3.09; P=.001), and clear cell histology (hazard ratio; 2.17, 95% confidence interval, 1.10–4.28; P=.03) portended for worse outcome.
Conclusion |
Patients ≥75 years with ovarian cancer old have an overall poor prognosis. Receiving neoadjuvant chemotherapy followed by interval cytoreductive surgery is associated with greater overall survival compared to chemotherapy alone.
Le texte complet de cet article est disponible en PDF.Key words : chemotherapy, cytoreduction, elderly women, neoadjuvant chemotherapy, ovarian cancer
Plan
| The authors report no conflict of interest. |
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| This research was supported by the Fisher Family Fund, Denise Hale Chair fund, and the San Francisco Women’s Leadership Group. Funders played no role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the article for publication. |
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| Cite this article as: Klein DA, Mann AK, Freeman AH, et al. Chemotherapy alone for patients 75 years and older with epithelial ovarian cancer—is interval cytoreductive surgery still needed? Am J Obstet Gynecol 2020;222:170.e1-11. |
Vol 222 - N° 2
P. 170.e1-170.e11 - février 2020 Retour au numéro
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