Chemotherapy in older adult gynecologic oncology patients: Can a phenotypic frailty score predict tolerance?

Hay, Casey M.; Donovan, Heidi S.; Campbell, Grace; Taylor, S.E.; Wang, Li; Courtney‐Brooks, Madeleine

doi:10.1016/j.ygyno.2018.11.031

Cited by 21 publications

(8 citation statements)

References 38 publications

(48 reference statements)

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“…We could hypothesize two main reasons potentially related to the decision of not performing lymphadenectomy in in real-life settings: i) the systematic removal of regional lymph nodes in endometrial cancer is associated with a non-negligible risk of lymphatic complications (particularly lower extremity lymphedema) causing severe morbidity, especially in elderly patients [ 11 ]. In support of this hypothesis, patients in NO-LND group were significantly elderly compared to those in LND group; ii) the higher number of patients with severe comorbidities in NO-LND group might have reduced the rate of eligibility for adjuvant treatment [ 19 ], thus potentially invalidating the diagnostic role of lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Casarin

Bogani

Piovano³

et al. 2020

J Gynecol Oncol

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Objective Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. Methods Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy “LND” vs. those who underwent hysterectomy alone “NO-LND”. Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). Results One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32–1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02–1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08–12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31–13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17–0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02–1.13; p<0.001). Conclusions Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.

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Section: Discussionmentioning

confidence: 99%

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Casarin

Bogani

Piovano³

et al. 2020

J Gynecol Oncol

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“…HAY et al prospectively evaluated eighty patients with ovarian cancer and found that age was not associated with tolerance to chemotherapy [ 31 ]. A case–control study conducted by Amadio showed that the incidence of severe toxicity in the young and older groups who received platinum-based chemotherapy and bevacizumab was comparable [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

Zhao

Zuo

et al. 2022

Cancers

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Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan–Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy.

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“…Besides, people with frailty were at higher risk for sarcopenia ( 39 ) and cancer-related cachexia ( 40 ), both of which have been related to a poor long-term survival of patients with OC ( 41 ). In addition, previous studies have shown that compared to non-frailty patients, OC patients with frailty were more likely to have postoperative morbidity ( 42 , 43 ) and mortality ( 44 ), ICU admission ( 45 ), and intolerance for the standard-of-care chemotherapy ( 46 ) compared to the none-frailty patients, all of which may lead to poor long-term survival in these patients. Subgroup analyses according to multiple study or patient characteristics showed a consistent association between frailty and poor OS in patients with OC, suggesting a universal role of frailty as a predictor of poor prognosis in OC patients with different ages and cancer stages.…”

Section: Discussionmentioning

confidence: 99%

Frailty and long-term survival of patients with ovarian cancer: A systematic review and meta-analysis

Yin²,

Li³

2022

Front. Oncol.

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BackgroundFrailty has been related with poor prognosis of various diseases, including ovarian cancer. We performed a systematic review and meta-analysis to evaluate the association between frailty and long-term survival of patients with ovarian cancer.MethodsRelevant cohort studies were retrieved by search of PubMed, Embase, Cochrane’s Library, and Web of Science electronic databases. Two authors independently performed literature search, data collection, and statistical analyses. A random-effect model incorporating the possible influence of heterogeneity was used to pool the results.ResultsNine cohort studies including 2497 women with confirmed diagnosis of ovarian cancer contributed to the meta-analysis, and 536 (21.5%) of them were with high frailty. The median follow-up durations varied between 24 and 69 months. Compared to patients with low or non-frailty, OC patients with high frailty were associated with poor overall survival (risk ratio [RR]: 1.61, 95% confidence interval [CI]: 1.41 to 1.85, p < 0.001; I2 = 0%) and progression-free survival (RR: 1.51, 95% CI: 1.20 to 1.89, p < 0.001; I2 = 0%). Subgroup analyses according to study design, cancer stage, age of patients, scales for frailty evaluation, follow-up duration, and quality score of the included study showed consistent association between high frailty and poor overall survival in women with ovarian cancer (p for subgroup effects all < 0.05). After considering GRADE criteria for strength of the evidence, it was rated low for both the two outcomes.ConclusionHigh frailty may be an independent risk factor of poor survival in women with ovarian cancer. Evaluating frailty may be important for predicting the prognosis and determining the optimal anticancer treatments in women with ovarian cancer.Systematic Review Registrationhttps://inplasy.com/, identifier INPLASY202290028.

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Chemotherapy in older adult gynecologic oncology patients: Can a phenotypic frailty score predict tolerance?

Cited by 21 publications

References 38 publications

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

Frailty and long-term survival of patients with ovarian cancer: A systematic review and meta-analysis

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