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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 415-421    DOI: 10.31083/j.ejgo.2020.03.5291
Original Research Previous articles | Next articles
Treatment and survival outcomes from epithelial ovarian cancer in women aged 65 years or older
Chenchen Zhu1, Hanyuan Liu1, Zhen Shen2, Yanhu Xie3, Tianjiao Zhang2, Björn Nashan4, Dabao Wu2, Ying Zhou1, 2()
1Department of Obstetrics and Gynecology, Anhui Provincial Hospital, Anhui Medical University,230001, Hefei, China
2Department of Obstetrics and Gynecology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230001, Hefei, China
3Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230001, Hefei, China
4Organ Transplantation Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 230001, Hefei, China
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Abstract  

Objective: To describe the clinical features associated with the treatment and survival outcomes of older women with epithelial ovarian cancer. Materials and methods: Fifty-five women aged ≥ 65 years and diagnosed with epithelial ovarian cancer were enrolled. The clinical characteristics, treatment procedure and survival outcomes were presented and analyzed. Results: The mean age at the time of epithelial ovarian cancer diagnosis was 69.9 ± 3.9 years, with most women presenting with advanced stage disease (83.6%). Thirty-five patients (63.6%) received optimal cytoreduction, of whom 23 underwent surgery with a low surgical complexity score Forty-two percent of patients presented with postoperative complications, while five patients presented with three or more postoperative complications simultaneously. The large majority (87.3%) of patients received chemotherapy, and more than half (42%) relapsed. The three-year overall survival rate was 52.8%, while three-year progression-free survival was 33.3%. Advanced FIGO stage and residual lesions were the factors associated with reduced overall survival (p < 0.0001, p = 0.004), FIGO stage was also associated with progression-free survival (p = 0.001). Conclusions: Aggressive surgical debulking and chemotherapy are feasible for older epithelial ovarian cancer patients. Advanced FIGO stage and residual lesions are associated with reduced survival.

Key words:  Geriatric patients      Epithelial ovarian cancer      Cytoreduction      Chemotherapy      Survival     
Submitted:  08 June 2019      Accepted:  05 September 2019      Published:  15 June 2020     
Fund: 81872110/National Natural Science Foundation of China;81272881/National Natural Science Foundation of China;8190263/National Natural Science Foundation of China;1704a0802151/Anhui Provincial Key Research and Development Program;2018YFC1003900National Key Research and Development Program;KLIICD-201603/Open Project of the CAS Key Laboratory of Innate Immunity and Chronic Disease Project;S20183400001/Anhui provincial innovative programme for organ transplantation
*Corresponding Author(s):  Ying Zhou     E-mail:  caddie1234@gmail.com

Cite this article: 

Chenchen Zhu, Hanyuan Liu, Zhen Shen, Yanhu Xie, Tianjiao Zhang, Björn Nashan, Dabao Wu, Ying Zhou. Treatment and survival outcomes from epithelial ovarian cancer in women aged 65 years or older. European Journal of Gynaecological Oncology, 2020, 41(3): 415-421.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5291     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/415

Figure 1.  - The inclusion process and treatment process of patients recruited in this study. #: two cases of recurrent EOC underwent secondary cytoreduction, three cases of biopsy. EOC: Epithelial ovarian cancer; NACT: Neoadjuvant chemotherapy

Table 1  - Clinical and pathology characteristics of 55 geriatric patients with epithelial ovarian cancer received surgeries in our hospital.
No. %
Total 55
Age (Mean ± SD) 69.91 ± 3.96
65-69 31 56.36
70-74 15 27.27
> 75 9 16.36
FIGO stage
I 8 14.55
II 1 1.82
III 42 76.36
IV 4 7.27
Pathological type
Serous 44 80.00
Mucinous 5 9.09
Endometriosis 0 0
Clear cell 6 10.91
Comorbid illnesses 29 52.73
Multiple comorbid 10 18.18
Disease type
Primary 53 96.36
Recurrent 2 3.64
Adjuvant Chemotherapy 48 87.27
< 6 32 58.18
≥ 6 23 41.82
Resistance 7 14.58a
Relapse 23 41.82
Table 2  - Type of comorbid illnesses.
No. (%)
Hypertension 16 (29.09)
Coronary artery disease 8 (14.55)
Diabetes 8 (14.55)
Other cancera 2 (3.64)
Other illnessesb 5 (9.09)
Table 3  - Surgical procedures and operative outcome in 55 geriatric patients with epithelial ovarian cancer.
No. %
Surgery 55 100
Staging Surgery 4 7.27
PCS 39 70.91
ICS 7 12.73
Other 5 9.09
Residual disease
R0a 29 52.73
R1b 6 10.91
RXc 20 36.36
ASA
1 2 3.64
2 30 54.54
3 23 41.82
CSG
Low 43 78.18
Intermediate 10 18.18
High 2 3.64
Postoperative complications 23 41.82
Estimated blood loss (EBL) 775.09 ± 758.31 (range 50 ~ 3000)
< 500 25 45.45
500-999 15 27.27
1000-1999 9 16.36
≥ 2000 6 10.91
Intraoperative Transfusion 26 47.27
Total hospital stay 20.38 ± 10.33 (range 11 ~ 83)
10-19 33 60
20-29 18 32.73
≥ 30 4 7.27
Postoperative hospital stay 12.93 ± 5.15 (range 6 ~ 30)
< 10 15 27.27
10-19 32 58.18
20-29 7 12.73
≥ 30 1 1.82
Postoperative interval of initial chemotherapy 15.84 ± 9.95 (range 4 ~ 41 )
No chemotherapy 5 9.09
< 10 19 34.55
10-19 14 25.45
20-29 11 20
≥ 30 6 10.91
Table 4  - Type of Postoperative complications.
No. (%)
Hypoproteinemia 10 (18.18)
Wound dehiscence 3 (5.45)
Anemia 3 (5.45)
Hypokalemia 3 (5.45)
Ascites 3 (5.45)
Ventosity 3 (5.45)
Pulmonary infection 2 (3.64)
Deep venous thrombosis 2 (3.64)
Renal dysfunction 2 (3.64)
Nausea and vomiting 2 (3.64)
Diarrhea 2 (3.64)
Ileus 1 (1.82)
arrhythmia 1 (1.82)
Ventosity 1 (1.82)
Table 5  - Simultaneous occurrence of three or more surgical complication.
No Age Stage Residual lesions Surgery Complications Status Overall survival
1 67 IIIc Low RX PCS Hypoproteinemia, hyponatremia, renal dysfunction, ventosity Died 18
2 72 IIIc Low RX PCS Hypoproteinemia, ascites, Deep venous thrombosis Died 22
3 67 IIIc Low RX PCS Ventosity, Nausea and vomiting, arrhythmia Died 42
4 78 IIIc Low R0 ICS Hypoproteinemia, ascites, Hypokalemia, Nausea and vomiting, Diarrhea Died 35
5 67 IIIc Low R0 ICS Wound dehiscence, Ileus, Pulmonary infection, Deep venous thrombosis Survival 8
Figure 2.  - A. Kaplan-Meier estimate of overall survival and progression-free survival by patients’ age.

Figure 3.  - Kaplan-Meier estimate of overall survival and progression-free survival by FIGO stage.

Figure 4.  - Kaplan-Meier estimate of overall survival and progression-free survival by the score of ASA.

Figure 5.  - Kaplan-Meier estimate of overall survival and progression-free survival by the residual lesions.

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