Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Ferrero, Annamaria; Fuso, Luca; Tripodi, Elisa; Tana, Roberta; Daniele, Alberto; Zanfagnin, Valentina; Perotto, Stefania; Gadducci, Angiolo

doi:10.1097/igc.0000000000001097

Cited by 35 publications

(42 citation statements)

References 29 publications

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“…This suggests that neither age nor phenotypic assessment of patient frailty are good predictors of ability to tolerate chemotherapy in this population. This parallels findings from a recent retrospective study in older adult ovarian cancer patients that found neither age nor frailty was associated with chemotherapy toxicity 39 . The idea of a phenotypic frailty assessment is appealing as physicians attempt to find simple and efficient ways to move away from relying purely on age to determine when older adult patients cannot tolerate SOCC.…”

Section: Discussionsupporting

confidence: 87%

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

Hay

Donovan

Campbell

et al. 2019

Gynecologic Oncology

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Objective-Evaluate the ability of an office-administered phenotypic frailty assessment to predict chemotherapy tolerance in older adult gynecologic oncology patients, and describe practice patterns for chemotherapy administration in this population.Methods-Prospective, single-institution cohort study of gynecologic oncology patients 65 or older initiating chemotherapy. Phenotypic frailty testing at an office visit encompassed components of two validated frailty assessments: Fried Score (physical testing and patient response) and FRAIL Scale (patient response only). Patients were followed through three cycles of neoadjuvant chemotherapy or six cycles of adjuvant chemotherapy. Standard statistics examined the relationship of frailty to chemotherapy regimen, ability to complete chemotherapy, and complications.Results-Eighty patients were included, 65% with ovarian and 34% with endometrial cancer. On average 57% of patients were fit, 32% intermediately frail, and 11% frail. 68% received adjuvant chemotherapy versus 32% neoadjuvant. The majority (81%) received IV chemotherapy on a 21day cycle and 81% initially received a regimen consistent with standard-of-care chemotherapy (SOCC). Age was not associated with receiving SOCC, or tolerance or completion of chemotherapy. Frailty was associated with non-initiation of SOCC in all patients and inability to complete SOCC in adjuvant patients. Complications and regimen alterations were common but were not associated with frailty.

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Section: Discussionsupporting

confidence: 87%

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

Hay

Donovan

Campbell

et al. 2019

Gynecologic Oncology

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“…Several OC clinicopathologic factors, such as stage, age, and histological grade type were taken into consideration. As expected, in addition to patient age (Table 2, P = 0.01), which is already a known OC risk factor (Ferrero et al, 2017), the STAT3-FOS clique was significantly associated with survival in the univariate (Table 2, P = 6.22e-4) and multivariate analysis (Table 2, P = 1.05e-3), indicating the potential independent prognostic ability of this clique.…”

Section: Survival Analysis Of a Stat3-fos-regulating Tf-lncrna Cliquesupporting

confidence: 74%

Dynamic TF-lncRNA Regulatory Networks Revealed Prognostic Signatures in the Development of Ovarian Cancer

Guo

Wang

Gao

et al. 2020

Front. Bioeng. Biotechnol.

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The pathological development of ovarian cancer (OC) is a complex progression that depends on multiple alterations of coding and non-coding genes. Therefore, it is important to capture the transcriptional-regulating events during the progression of OC development and to identify reliable markers for predicting clinical outcomes in patients. A dataset of 399 ovarian serous cystadenocarcinoma patients at different stages from The Cancer Genome Atlas (TCGA) was analyzed. Stage-specific transcription factor (TF)-long non-coding RNA (lncRNA) regulatory networks were constructed by integrating high-throughput RNA molecular profiles and TF binding information. Systematic analysis was performed to characterize the TF-lncRNA-regulating behaviors across different stages of OC. Cox regression analysis and Kaplan-Meier survival curves were used to evaluate the prognostic efficiency of TF-lncRNA regulations and cliques. The stage-specific TF-lncRNA regulatory networks at three OC stages (II, III, and IV) exhibited common structures and specific topologies of risk TFs and lncRNAs. A TF-lncRNA activity profile across different stages revealed that TFs were highly stage-selective in regulating lncRNAs. Functional analysis indicated that groups of TF-lncRNA interactions were involved in specific pathological processes in the development of OC. In a STAT3-FOS co-regulating clique, the TFs STAT3 and FOS were selectively regulating target lncRNAs across different OC stages. Further survival analysis indicated that this TF-lncRNA biclique may have the potential for predicting OC prognosis. This study revealed the topological and dynamic principles of TF-lncRNA regulatory networks and provided a resource for further analysis of stage-specific regulating mechanisms of OC.

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“…7 Recently, the concept of patient frailty has been suggested as an accurate predictor of adverse postoperative outcomes in various malignancies. 14,[36][37][38] There are multiple purported measures of frailty; however the mFI (a simplification of the Canadian Study of Health and Aging Frailty Index) 25,26 appears to have gained the most traction in recent literature.…”

Section: Discussionmentioning

confidence: 99%

Validating the predictors of outcomes after radical cystectomy for bladder cancer

Woldu

Şanlı

Clinton

et al. 2018

Cancer

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Background An assessment of surgical risk is essential for patient counseling and decision making, and it can provide rationale adjustment for patient populations as health care moves from a fee‐for‐service to a value‐based reimbursement model. The modified Frailty Index (mFI) has been proposed as a risk‐stratification tool for radical cystectomy (RC), and the objective of the current study was to validate this potential use of the mFI using an institutional cohort. Methods A retrospective review of all patients who underwent RC for bladder cancer was conducted at the authors’ institution from 2012 to 2016. In addition to detailed clinicopathologic and treatment parameters, patients were categorized according to the mFI, the Charlson Comorbidity Index (CCI), and the American Society of Anesthesiologists (ASA) classification. Covariates were analyzed to determine associations with 1‐month complication rates (according to the Clavien‐Dindo system), 3‐month readmission rates, hospitalization length, and hospitalization costs. Results In total, 346 patients were included in the analysis. The overall complication rate was 56.6%, the major (Clavien grade ≥3) complication rate was 19.4%, and the readmission rate was 27.9%. Receiver operating curve analysis demonstrated a weak association of all indices with major complications after RC: the area under the curve was 0.535 (95% confidence interval [CI], 0.460‐0.611) for the ASA classification; 0.565 (95% CI, 0.485‐0.645) for the CCI score; and 0.551 (95% CI, 0.471‐0.631) for the mFI. There were no significant differences in the rate of major complications when stratifying the results according to the mFI, CCI, or ASA class. Length of hospitalization and associated costs were correlated with mFI. Conclusions Frailty was not associated with postoperative complications and provided little additional predictive ability over the ASA classification and the CCI score. Further research is required to identify patients who are likely to suffer significant complications after RC.

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Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index

Abstract: Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selected. The pretreatment assessment of frailty through mFI could be suggested in the surgical and medical management.

Cited by 35 publications

References 29 publications

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

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

Dynamic TF-lncRNA Regulatory Networks Revealed Prognostic Signatures in the Development of Ovarian Cancer

Validating the predictors of outcomes after radical cystectomy for bladder cancer

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