title: Treating gynecologic malignancies in elderly patients.
abstract: OBJECTIVE
  To determine the relative benefits of full and partial treatment for gynecologic malignancies in elderly patients.
  
  
  METHODS
  A retrospective cohort study of all consecutive patients (n=169) aged 79 and older (median age 82 y; range, 79 to 94 y), diagnosed between 1971 and 2007 with various types of gynecologic malignancies (endometrial, 52%; ovarian, 26%; vulvar, 11%; cervical, 5%; other, 6%) was conducted. Stages were I to II (47%), III to IV (35.5%), and unknown (17.5%). Major comorbidities were hypertension (51%), diabetes (17%), cardiac diseases (34%), and other malignancy (12%). Regardless of age or chronic illnesses, patients were grouped on the basis of having been treated optimally (100 patients; 59.2%), defined as the accepted standard for each diagnosis and stage including surgery and adjuvant radiation or chemotherapy as indicated; or suboptimally (69 patients; 40.8%), that is, no or only partial treatment. Kaplan-Meier survival analysis and Cox proportional hazard models, univariate and multivariable were conducted.
  
  
  RESULTS
  For all patients with suboptimal treatment, the age-and-stage-adjusted hazard ratio for death was 1.76 (95% CI, 1.203-2.570; P=0.004) compared with optimal treatment. Age-adjusted hazard ratio was 2.15 (95% CI, 1.127-4.114; P=0.02) and 2.3 (95% CI, 1.415-3.779; P=0.001) for ovarian and endometrial cancer patients, respectively. Age-adjusted and stage-adjusted hazard ratio was 2.8 (95% CI, 1.099-5.157; P=0.028) and 1.53 (95% CI, 0.867-2.702; P=0.1420) for ovarian and endometrial cancer patients, respectively.
  
  
  CONCLUSIONS
  Optimal treatment in patients with gynecologic malignancies evidently improves survival in elderly patients at any age, and in patients with ovarian cancer at any stage. Regardless of chronological age, the aim should be to deliver optimal treatment.
authors.affiliation: *Department of Gynecologic Oncology, Sheba Medical Center, Tel Hashomer †Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Perri
authors.forename: Tanya
authors.initials: T
authors.lastname: Katz
authors.forename: Jacob
authors.initials: J
authors.lastname: Korach
authors.forename: Mario E
authors.initials: ME
authors.lastname: Beiner
authors.forename: Ariella
authors.initials: A
authors.lastname: Jakobson-Setton
authors.forename: Gilad
authors.initials: G
authors.lastname: Ben-Baruch
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate