Elsevier

Surgical Oncology

Volume 13, Issue 4, December 2004, Pages 181-186
Surgical Oncology

Poorer survival of elderly patients with ovarian cancer: a population-based study

https://doi.org/10.1016/j.suronc.2004.08.010Get rights and content

Abstract

Objective: To compare ovarian cancer survival in elderly and young patients.

Material and methods: Using the Geneva Cancer Registry, we identify women diagnosed with primary ovarian cancer between 1980 and 1998. We compared tumors characteristics, treatment patterns of young patients (⩽70 years) versus older patients (>70 years) by logistic regression. To evaluate the effect of age on prognosis, we compared disease specific survival by Cox proportional hazard analysis, taking into account other prognostic factors.

Results: This study included 285 patient aged 70 years and 451⩽70 years. Older women presented more advanced stage and at equal stage were less often treated by optimal surgery and chemotherapy. Five-year of disease specific survival was 18% (95% CI: 13–23%) and 53% (95% CI: 48–58%) among old versus young women. Over ovarian mortality was only partly explained by these differences and after adjustment for tumor characteristics and treatment, older women still had a 1.8-fold increased risk of dying of ovarian cancer compared to younger (HR 1.8, 95% CI: 1.4–2.4).

Conclusion: Age strongly decreases ovarian cancer mortality. This over mortality is only partly explained by later diagnosis and suboptimal treatment.

Introduction

Ovarian cancer is a devastating disease and one of the leading causes of death from cancer [1]. It is the fifth most common cancer in women. Ovarian cancer is a disease of the elderly, as its incidence is increasing with advancing age and peaking during the 7th decade of life [2]. In the future, as the population in western countries is aging rapidly, the number of elderly women who will need to be treated for ovarian cancer can be expected to increase.

Prior studies have shown that older age is a significant adverse risk factor for survival and that elderly women have the poorest outcome. The reason for this effect is not entirely known, it was suggested that elderly patients are associated with a later diagnosis and a more advanced disease at initial presentation as compared to younger and as a consequence they have a poor clinical outcome. However, in studies which have considered this issue and adjusted for risk factors as advanced stage, it has been demonstrated that age is stay and independent adverse prognostic factor [3], [4].

In the past 25 years, ovarian cancer survival has significantly improved and this improvement is generally attributed to optimal surgical treatment (cytoreduction) and to the use of more effective new chemotherapy drugs. Both cytoreductive surgery and chemotherapy require good physiologic capacities and because elderly patients are more likely to have co-morbid conditions as hypertension, cardiac disease, diabetes or others contraindicating these therapeutic approaches, they are less likely to receive optimal surgery and chemotherapy [5], [6]. Two recent retrospective population-based studies have shown that older women with advanced ovarian cancer were less likely than younger to receive chemotherapy, to be treated by oncology specialists and to undergo adequate primary cytoreductive surgery [7], [8]. Therefore, we can ask if the poorer outcome of the elderly is due to a less aggressive management than their younger counterparts.

The aim of our study was to establish tumor characteristics and treatment among old women compared to younger ones, and evaluate the effect of age on ovarian cancer survival after adjustment for other prognosis factors.

Section snippets

Selection of patients

The study included all ovarian cancer cases (ICD-O code 56.9) occurring among women diagnosed between January 1980 and December 1998, resident in the Swiss canton of Geneva (n=756). We excluded patients with borderline tumours or non-epithelial ovarian cancer and cases of ovarian cancer diagnosed at death.

Variables

The Geneva Cancer Registry records all incident cases of cancers occurring in the population of the canton (approximately 420,000 inhabitants) since 1970. Registration is based on various

Results

Table 1 displays the characteristics of ovarian cancer patients according to age at diagnosis. A total of 451 (61%) patients were 70 years old or less and 285 (39%) were older than 70 years. Compared to younger women, older patients were more frequently treated in public institutions (p<0.001), had less often screened detected tumors (p<0.001), had more frequently mixed histological subtypes (p<0.001), less often well differentiated tumors (p=0.008), and more advanced disease at diagnosis (p=

Discussion

Ovarian cancer treatment in elderly women is not well documented. Despite the increasing number of elderly cancer patients, treatment recommendations for this group are often inconsistent and quite different from those for younger women. Main reason is that elderly have often co-morbid conditions as heart disease, impaired renal and liver function and are therefore generally excluded from clinical trials [13], [14].

The current data available regarding the oncologic treatments in elderly

Acknowledgements

Dr. HM Verkooijen was financially supported by PROSPER Grant (3233-069350) from the Swiss National Science Foundation.

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