title: Prognostic factors for ovarian epithelial cancer in the elderly: a case-control study.
abstract: OBJECTIVE
  Ovarian cancer is the leading cause of mortality by gynecologic cancers in Western countries. Many publications have suggested that age may be an independent prognostic factor in ovarian carcinoma. There are only few data concerning the impact of treatments and geriatric features within the elderly population.
  
  
  METHODS
  We collected data of older (≥ 70 years old) patients treated in our institution for an invasive ovarian carcinoma between 1995 and 2011. First we described usual clinical and pathological features for these patients, as well as their outcome. We compared these parameters with that of young (<70 years old) patients treated during the same period. We then observed geriatric features in our set: Eastern Cooperative Oncology Group performance status, number of medications, Charlson index, body mass index, hemoglobin, and glomerular filtration rate. We finally looked for prognostic factors specific of the elderly population.
  
  
  RESULTS
  One hundred nine elderly patients were identified and compared with 488 younger cases. There was no difference concerning clinicopathologic data. Surgery was more frequently complete in young women (58% vs 41.7%), and older patients received less chemotherapy courses and less taxanes (38.4% vs 67.1%). Young patients had a longer overall survival (median, 65.2 vs 26.2 months, P = 8.5E-10, log-rank test). Multivariate analyses confirmed that age was an independent prognostic factor and that within the elderly set the International Federation of Gynecology and Obstetrics stage, surgery results, number of chemotherapy cycles administered and performance status had a significant prognostic value. No clear correlation could be observed between geriatric characteristics and treatments administration.
  
  
  CONCLUSIONS
  Ovarian cancer prognosis is poorer for older women, but they are more frequently suboptimally treated. No correlation could be observed between geriatric factors and surgery or chemotherapy achievement. Treatment decision should be based on objective geriatric assessment in order to improve outcome in this population.
authors.affiliation: *Department of Medical Oncology, Institut Paoli-Calmettes; †Department of Molecular Oncology, INSERM U1068, CNRS U7258, Centre de Recherche en Cancérologie de Marseille; ‡Aix-Marseille University; and §Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Sabatier
authors.forename: Benoît
authors.initials: B
authors.lastname: Calderon
authors.forename: Eric
authors.initials: E
authors.lastname: Lambaudie
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Chereau
authors.forename: Magali
authors.initials: M
authors.lastname: Provansal
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: Cappiello
authors.forename: Patrice
authors.initials: P
authors.lastname: Viens
authors.forename: Frederique
authors.initials: F
authors.lastname: Rousseau
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult