title: Prognostic factors in young ovarian cancer patients: An analysis of four prospective phase III intergroup trials of the AGO Study Group, GINECO and NSGO.
abstract: We evaluated in a large study meta-database of prospectively randomised phase III trials the prognostic factors for progression-free survival (PFS) and overall survival (OS) in patients < and >40 years of age with advanced epithelial ovarian cancer.
  
  
  
  A total of 5055 patients of the AGO, GINECO, NSGO intergroup studies AGO-OVAR 3, 5, 7 and 9 were merged to identify 294 patients <40 years and 4761 patients ≥40 years. We conducted survival analyses and Cox proportional hazard regression models and additionally analysed a very homogeneous subcohort of 405 patients with serous epithelial ovarian cancer, excellent performance status, who had received complete macroscopic upfront cytoreduction and ≥5 chemotherapy cycles.
  
  
  
  For patients <40 years, the median PFS was 28.9 months and the median OS was 75.3 months, while the median PFS for patients ≥40 years was 18.1 months and the median OS was 45.7 months. Independent prognostic factors were similar in both age groups. In a multivariate analysis including prognostic factors potentially leading to confounding, young age appeared to improve PFS (hazard ratio [HR], 0.86; 95% confidence interval [CI]: 0.72-1.03) and OS (HR, 0.73; 95% CI: 0.59-0.91). The observed effect was even stronger in the subcohort of optimally treated patients with SEOC: PFS (HR, 0.34; 95% CI: 0.19-0.59) and OS (HR, 0.23; 95% CI: 0.09-0.56).
  
  
  
  Prognostic factors were similar in both age groups. Young age appeared a strong independent protective prognostic factor for PFS and OS in the subcohort.
authors: Department of Obstetrics and Gynecology, University Clinics of Freiburg, Freiburg, Germany.
authors: M
authors: M
authors: Klar
authors: Department of Obstetrics and Gynecology, University Clinics of Mainz, Mainz, Germany. Electronic address: annette.hasenburg@unimedizin-mainz.de.
authors: A
authors: A
authors: Hasenburg
authors: Department of Obstetrics and Gynecology, University Clinics of Freiburg, Freiburg, Germany.
authors: M
authors: M
authors: Hasanov
authors: Gynecologic Oncology Centre, Kiel, Germany.
authors: F
authors: F
authors: Hilpert
authors: Department of Obstetrics and Gynecology, University Clinics of München, München, Germany.
authors: W
authors: W
authors: Meier
authors: Gynecologic Oncology Centre, Kiel, Germany.
authors: J
authors: J
authors: Pfisterer
authors: Department of Obstetrics and Gynecology, Hôpital Hôtel-Dieu, Paris, France.
authors: E
authors: E
authors: Pujade-Lauraine
authors: Department of Oncology, Odense University Hospital, Odense, Denmark.
authors: J
authors: J
authors: Herrstedt
authors: Coordinating Centre for Clinical Trials, University Marburg, Marburg, Germany.
authors: A
authors: A
authors: Reuss
authors: Department of Obstetrics and Gynecology, University Clinics of München, München, Germany; Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen, Germany.
authors: A
authors: A
authors: du Bois
mesh_terms: D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000077216:Carcinoma, Ovarian Epithelial; D017326:Clinical Trials, Phase III as Topic; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy / Q000401:mortality*; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: Ovarian cancer; Prognostic factors; Younger patients