Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer: A delicate balance requiring individualization

C. Langstraat, G. D. Aletti, W. A. Cliby

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: To assess outcomes and identify underlying predictors of outcomes in a cohort of women over the age of 65 treated for primary ovarian cancer (OC). Methods: Consecutive patients ≥ 65 with stage IIIC or IV OC treated with primary surgery and adjuvant chemotherapy at Mayo Clinic between January 1, 1994 and December 31, 2004 were retrospectively assessed. We analyzed the impact of perioperative factors (age, albumin, CA125, American Society of Anesthesiologist (ASA) score, amount of ascites, presence of carcinomatosis, creatinine, need for urgent surgery, stage of disease, surgical complexity score and amount of residual disease) on surgical outcomes (morbidity, mortality, overall survival (OS) and ability to receive chemotherapy). Results: Two hundred eighty patients met inclusion criteria. Age was associated with higher ASA score, lower albumin, and higher creatinine; stage, diffuse peritoneal disease, and surgical complexity were not associated with age. Median OS decreased with increasing age and residual disease (RD), and the impact of RD was greater on older patients. All patients benefited similarly when RD = 0 [median OS 5.9 years for age 65-69 vs. 5.0 years in those ≥ 80 (p = 0.5516)], for RD <1 cm, and OS was 3.4 vs. 2.1 years respectively for youngest vs. oldest patients (p = 0.068). Perioperative morbidity was observed in 37.5% of patients ≥ 75. Independent predictors of poor perioperative outcome included preoperative albumin ≤ 3 g/dL, urgent surgery, age, and stage (p <0.05). Independent predictors of overall survival included creatinine, albumin, surgical complexity score, amount of residual disease, stage and age. Conclusion: Age is an independent predictor of OS in OC. A significant number of elderly women are able to undergo a complete cytoreduction and experience OS similar to that of younger patients. However, the benefits to incomplete cytoreduction are less clear in women ≥ 75. These observations highlight the need to use emerging predictors of outcomes in decision making and to focus care in centers able to render patients with no visible residual disease.

Original languageEnglish
Pages (from-to)187-191
Number of pages5
JournalGynecologic Oncology
Volume123
Issue number2
DOIs
Publication statusPublished - Nov 2011

Fingerprint

Ovarian Neoplasms
Morbidity
Survival
Mortality
Albumins
Creatinine
Peritoneal Diseases
Aptitude
Age Factors
Adjuvant Chemotherapy
Ascites
Decision Making
Carcinoma
Drug Therapy

Keywords

  • Elderly
  • Ovarian carcinoma
  • Surgical morbidity

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

Cite this

@article{229858a794fa4b8dbc3de1391f2e9290,
title = "Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer: A delicate balance requiring individualization",
abstract = "Objective: To assess outcomes and identify underlying predictors of outcomes in a cohort of women over the age of 65 treated for primary ovarian cancer (OC). Methods: Consecutive patients ≥ 65 with stage IIIC or IV OC treated with primary surgery and adjuvant chemotherapy at Mayo Clinic between January 1, 1994 and December 31, 2004 were retrospectively assessed. We analyzed the impact of perioperative factors (age, albumin, CA125, American Society of Anesthesiologist (ASA) score, amount of ascites, presence of carcinomatosis, creatinine, need for urgent surgery, stage of disease, surgical complexity score and amount of residual disease) on surgical outcomes (morbidity, mortality, overall survival (OS) and ability to receive chemotherapy). Results: Two hundred eighty patients met inclusion criteria. Age was associated with higher ASA score, lower albumin, and higher creatinine; stage, diffuse peritoneal disease, and surgical complexity were not associated with age. Median OS decreased with increasing age and residual disease (RD), and the impact of RD was greater on older patients. All patients benefited similarly when RD = 0 [median OS 5.9 years for age 65-69 vs. 5.0 years in those ≥ 80 (p = 0.5516)], for RD <1 cm, and OS was 3.4 vs. 2.1 years respectively for youngest vs. oldest patients (p = 0.068). Perioperative morbidity was observed in 37.5{\%} of patients ≥ 75. Independent predictors of poor perioperative outcome included preoperative albumin ≤ 3 g/dL, urgent surgery, age, and stage (p <0.05). Independent predictors of overall survival included creatinine, albumin, surgical complexity score, amount of residual disease, stage and age. Conclusion: Age is an independent predictor of OS in OC. A significant number of elderly women are able to undergo a complete cytoreduction and experience OS similar to that of younger patients. However, the benefits to incomplete cytoreduction are less clear in women ≥ 75. These observations highlight the need to use emerging predictors of outcomes in decision making and to focus care in centers able to render patients with no visible residual disease.",
keywords = "Elderly, Ovarian carcinoma, Surgical morbidity",
author = "C. Langstraat and Aletti, {G. D.} and Cliby, {W. A.}",
year = "2011",
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pages = "187--191",
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T1 - Morbidity, mortality and overall survival in elderly women undergoing primary surgical debulking for ovarian cancer

T2 - A delicate balance requiring individualization

AU - Langstraat, C.

AU - Aletti, G. D.

AU - Cliby, W. A.

PY - 2011/11

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N2 - Objective: To assess outcomes and identify underlying predictors of outcomes in a cohort of women over the age of 65 treated for primary ovarian cancer (OC). Methods: Consecutive patients ≥ 65 with stage IIIC or IV OC treated with primary surgery and adjuvant chemotherapy at Mayo Clinic between January 1, 1994 and December 31, 2004 were retrospectively assessed. We analyzed the impact of perioperative factors (age, albumin, CA125, American Society of Anesthesiologist (ASA) score, amount of ascites, presence of carcinomatosis, creatinine, need for urgent surgery, stage of disease, surgical complexity score and amount of residual disease) on surgical outcomes (morbidity, mortality, overall survival (OS) and ability to receive chemotherapy). Results: Two hundred eighty patients met inclusion criteria. Age was associated with higher ASA score, lower albumin, and higher creatinine; stage, diffuse peritoneal disease, and surgical complexity were not associated with age. Median OS decreased with increasing age and residual disease (RD), and the impact of RD was greater on older patients. All patients benefited similarly when RD = 0 [median OS 5.9 years for age 65-69 vs. 5.0 years in those ≥ 80 (p = 0.5516)], for RD <1 cm, and OS was 3.4 vs. 2.1 years respectively for youngest vs. oldest patients (p = 0.068). Perioperative morbidity was observed in 37.5% of patients ≥ 75. Independent predictors of poor perioperative outcome included preoperative albumin ≤ 3 g/dL, urgent surgery, age, and stage (p <0.05). Independent predictors of overall survival included creatinine, albumin, surgical complexity score, amount of residual disease, stage and age. Conclusion: Age is an independent predictor of OS in OC. A significant number of elderly women are able to undergo a complete cytoreduction and experience OS similar to that of younger patients. However, the benefits to incomplete cytoreduction are less clear in women ≥ 75. These observations highlight the need to use emerging predictors of outcomes in decision making and to focus care in centers able to render patients with no visible residual disease.

AB - Objective: To assess outcomes and identify underlying predictors of outcomes in a cohort of women over the age of 65 treated for primary ovarian cancer (OC). Methods: Consecutive patients ≥ 65 with stage IIIC or IV OC treated with primary surgery and adjuvant chemotherapy at Mayo Clinic between January 1, 1994 and December 31, 2004 were retrospectively assessed. We analyzed the impact of perioperative factors (age, albumin, CA125, American Society of Anesthesiologist (ASA) score, amount of ascites, presence of carcinomatosis, creatinine, need for urgent surgery, stage of disease, surgical complexity score and amount of residual disease) on surgical outcomes (morbidity, mortality, overall survival (OS) and ability to receive chemotherapy). Results: Two hundred eighty patients met inclusion criteria. Age was associated with higher ASA score, lower albumin, and higher creatinine; stage, diffuse peritoneal disease, and surgical complexity were not associated with age. Median OS decreased with increasing age and residual disease (RD), and the impact of RD was greater on older patients. All patients benefited similarly when RD = 0 [median OS 5.9 years for age 65-69 vs. 5.0 years in those ≥ 80 (p = 0.5516)], for RD <1 cm, and OS was 3.4 vs. 2.1 years respectively for youngest vs. oldest patients (p = 0.068). Perioperative morbidity was observed in 37.5% of patients ≥ 75. Independent predictors of poor perioperative outcome included preoperative albumin ≤ 3 g/dL, urgent surgery, age, and stage (p <0.05). Independent predictors of overall survival included creatinine, albumin, surgical complexity score, amount of residual disease, stage and age. Conclusion: Age is an independent predictor of OS in OC. A significant number of elderly women are able to undergo a complete cytoreduction and experience OS similar to that of younger patients. However, the benefits to incomplete cytoreduction are less clear in women ≥ 75. These observations highlight the need to use emerging predictors of outcomes in decision making and to focus care in centers able to render patients with no visible residual disease.

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KW - Ovarian carcinoma

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