Impact of age, comorbidity, and treatment characteristics on survival in older women with advanced high grade epithelial ovarian cancer

Mallen, Adrianne; Todd, Sarah; Robertson, Sharon E.; Kim, Jongphil; Sehovic, Marina; Extermann, Martine; Chon, Hye Sook

doi:10.1016/j.ygyno.2021.03.008

Cited by 17 publications

(26 citation statements)

References 27 publications

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“…ECOG was also a prognostic factor for OS. Age and performance status are associated with survival outcomes in lung cancer as well as other malignancies, such as aerodigestive tract and gynecologic cancers [10,[43][44][45][46]. The aged population has more medical comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

et al. 2021

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We investigated whether the combination of primary tumor and nodal 18F-FDG PET parameters predict survival outcomes in patients with nodal metastatic non-small cell lung cancer (NSCLC) without distant metastasis. We retrospectively extracted pre-treatment 18F-FDG PET parameters from 89 nodal-positive NSCLC patients (stage IIB–IIIC). The Cox proportional hazard model was used to identify independent prognosticators of overall survival (OS) and progression-free survival (PFS). We devised survival stratification models based on the independent prognosticators and compared the model to the American Joint Committee on Cancer (AJCC) staging system using Harrell’s concordance index (c-index). Our results demonstrated that total TLG (the combination of primary tumor and nodal total lesion glycolysis) and age were independent risk factors for unfavorable OS (p < 0.001 and p = 0.001) and PFS (both p < 0.001), while the Eastern Cooperative Oncology Group scale independently predicted poor OS (p = 0.022). Our models based on the independent prognosticators outperformed the AJCC staging system (c-index = 0.732 versus 0.544 for OS and c-index = 0.672 versus 0.521 for PFS, both p < 0.001). Our results indicate that incorporating total TLG with clinical factors may refine risk stratification in nodal metastatic NSCLC patients and may facilitate tailored therapeutic strategies in this patient group.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

et al. 2021

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“…According to a study by Janssen-Heijnen et al [ 11 ], the recommended surgical and chemotherapeutic treatments were implemented in a significantly lower percentage of patients with FIGO stage II–III OC who had at least one concomitant disease, regardless of age, over or under 70 years old [ 11 ]. Mallen et al [ 13 ] compared older OC patients over 70 with those younger than 70. The authors believed that concomitant diseases were not responsible for a worse prognosis in adults.…”

Section: Discussionmentioning

confidence: 99%

“…The authors believed that concomitant diseases were not responsible for a worse prognosis in adults. According to the authors, the different tumor biology, characterized by greater aggressiveness and resistance to platinum, contributed to lower survival of the adult population, which also had more severe comorbidities (including cardiovascular diseases and diabetes mellitus) [ 13 ]. The researchers found that the lower the probability of optimal cytoreduction, the higher the chance of an inability to complete adjuvant chemotherapy, and more frequent resistance to platinum therapy were independent adverse factors in adults [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most researchers who have studied the impact of comorbidities on ovarian cancer survival consider cardiovascular diseases in conjunction with other comorbidities incorporated into the Charlson Comorbidity Index (CCI) or Ovarian Cancer Comorbidity Index (OCCI), assessing primarily overall survival. A meta-analysis of eight prospective studies involving more than 12,000 patients demonstrated an increased mortality risk in patients with concomitant diseases (HR 1.2, 95% CI 1.11–1.3) [ 13 ]. Noer et al (2018) confirmed that comorbidity was significantly associated with worse overall survival HR 1.36 (1.05–1.77), p = 0.020 [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Experts have investigated molecular and genetic changes in different histological types of OC to provide a specific target therapy [ 10 ]. In addition, many studies have addressed comorbidity and its correlation with ovarian cancer survival [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Cardiovascular diseases and diabetes may contribute directly to increased mortality in OC patients and indirectly through treatment selection, suboptimal surgery, and chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Survival in Advanced Epithelial Ovarian Cancer Associated with Cardiovascular Comorbidities and Type 2 Diabetes Mellitus

et al. 2021

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Background: Ovarian carcinoma (OC) is usually diagnosed at an advanced stage, necessitating a multimodal approach that includes surgery and systemic therapy. The incidence of OC is approximately five times higher in women over 65 years of age. Cardiovascular comorbidities and type 2 diabetes mellitus, both prevalent at this age, can influence therapeutic strategy and have an adverse effect on survival. Objectives: Our study aimed to determine the impact of cardiovascular diseases and diabetes mellitus on survival in advanced ovarian cancer. Materials and methods: From 2004 to 2012, we retrospectively studied 104 patients with advanced epithelial ovarian cancer (FIGO stage II–IV) who underwent surgical treatment at the Gynecology Clinic, St. Anna University Hospital, Varna, Bulgaria. Patients were followed for an average of 90 (52–129) months. We divided the study population into two groups: those with concurrent cardiovascular diseases and type 2 diabetes mellitus (CVD) and those without these comorbidities (No-CVD group). Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were compared between groups using Kaplan–Meier survival analysis. Cardiovascular comorbidities and diabetes mellitus were evaluated for their prognostic value for survival using multivariate Cox proportional regression analysis adjusted for age, stage of OC, grade and histological type of the tumor, ascites presence, residual tumor size (RT), performance status, and type of hysterectomy. Results: The Kaplan–Meier analysis showed reduced OS and DSS in the CVD group compared to the No-CVD group. The median OS was 24.5 months (95% CI 18.38 months) and 38 months (95% CI 26, not reached), respectively (Log-rank p = 0.045). The median DSS was 25.5 months (95% CI 19.39 months) and 48 months (95% CI 28, not reached), respectively (Log-rank p = 0.033). The Cox regression multivariate analysis established a lower (by 68%) overall survival rate for the CVD patient group than the No-CVD group, approaching statistical significance (HR 1.68, 95% CI 0.99, 2.86, p = 0.055). Cardiovascular diseases and diabetes were associated with a 79% reduction in DSS (HR 1.79, 95% CI 1.02, 3.13, p = 0.041) and a twofold increase in the risk of disease progression (HR 2.05, 95% CI 1.25, 3.37, p = 0.005). Conclusions: According to our study, cardiovascular comorbidities and diabetes may adversely affect OC survival. Optimal control of cardiovascular diseases, diabetes mellitus, and their risk factors may be beneficial for patients with advanced OC. Further research involving a larger patient population is necessary to establish these comorbidities as independent prognostic factors.

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Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study

Ekmann-Gade

Høgdall

Seibæk

et al. 2022

Gynecologic Oncology

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decreased among women <70 years of age but was stable for women ≥70 years during 2005-2018.• The proportion of patients with advanced EOC not undergoing debulking surgery increased from 2005 to 2018.• During the same period, the proportion of patients having 0 cm residual disease after debulking surgery increased.• During the same period, cancer-specific survival increased for both younger and older EOC patients.

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Impact of age, comorbidity, and treatment characteristics on survival in older women with advanced high grade epithelial ovarian cancer

Cited by 17 publications

References 27 publications

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

Prognostic Value of Combing Primary Tumor and Nodal Glycolytic–Volumetric Parameters of 18F-FDG PET in Patients with Non-Small Cell Lung Cancer and Regional Lymph Node Metastasis

Survival in Advanced Epithelial Ovarian Cancer Associated with Cardiovascular Comorbidities and Type 2 Diabetes Mellitus

Incidence, treatment, and survival trends in older versus younger women with epithelial ovarian cancer from 2005 to 2018: A nationwide Danish study

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