Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma
Performance status rather than age is the key prognostic factor in second-line treatment of elderly patients with epithelial ovarian carcinoma
复制标题
DOI：
10.1002/cncr.10385
复制
发表时间：
2002-04-01
期刊：
影响因子：
6.2
通讯作者：
Engelholm, SA
中科院分区：
文献类型：
--
作者：
Gronlund, B;Hogdall, C;Engelholm, SA
背景。由于担心毒性，许多老年患者拒绝使用静脉注射细胞抑制剂作为上皮性卵巢癌的二线治疗。本研究的目的是比较老年（大于65岁）和年轻（小于65岁）患者接受静脉二线治疗上皮性卵巢癌的毒性和疗效。方法。本研究对 286 名连续的原发性上皮性卵巢癌患者进行了回顾性分析。纳入标准包括组织病理学记录的国际妇产科联合会 (FIGO) IC-IV 期上皮性卵巢癌；使用紫杉醇和铂类似物进行一线治疗；静脉二线治疗，拓扑替康 1.0 mg/m(2)/天，持续 5 天，每 3 周一次，或紫杉醇 (175 mg/m(2)) 和卡铂 (AUC 5)，每 3 周一次。 结果。 102 名患者因难治性或复发性疾病而符合纳入标准，接受拓扑替康 (n = 57) 或紫杉醇卡铂 (n = 45) 治疗。年轻组（n = 68）和老年组（n = 34）患者开始二线治疗时的中位年龄分别为 54.0 岁（范围，34.7-64.3）和 69.5 岁（范围，65.1-77.2）。在年龄小于 65 岁的患者组中，初始体能状态比年龄大于 65 岁的患者更有利 (P = 0.007)，而各组在其他潜在预后因素方面相似 (P > 0.05)。对于年龄小于 65 岁的患者，总体缓解率为 50%（95% 置信区间 [CI]，37-63%），与年龄大于 65 岁的患者的缓解率为 44%（95% CI，27-62%）相似（P = 0.29）。年龄小于 65 岁和大于 65 岁的患者从二线治疗第一天开始的总生存期中位分别为 13.3+ 个月（范围，1.2-38.3+）和 11.8+ 个月（范围，2.0-41.0+）（P = 0.25）。在多变量 Cox 分析中，一线治疗时的体能状态（0 vs.1-2；P = 0.013；风险比 [HR]，2.12）、二线治疗时的体能状态（0 vs.1-2；P = 0.004；HR，2.47）以及对二线治疗的反应（CR + PR vs. NC + PD；P < 0.001；HR， 4.38）被发现是总体生存的独立重要因素，而年龄（小于 65 岁与大于 65 岁）没有产生独立信息（P = 0.90）。老年患者和年轻患者之间的治疗推迟率、中性粒细胞减少症4级、血小板减少症3-4级以及对任一细胞抑制剂的过敏反应均无差异（P>0.05）。结论。上皮性卵巢癌的二线治疗方式应更多地通过评估体能状态而不是年龄本身来确定。拓扑替康或紫杉醇卡铂二线治疗可以安全地用于老年人。
BACKGROUND. intravenous cytostatic agents as second-line treatment of epithelial ovarian carcinoma have been withheld from many elderly patients because of fear of toxicity. The purpose of the study is to compare the toxicity and efficacy between elderly (older than 65 years of age) and younger (younger than 65 years of age) patients receiving intravenous second-line treatment of epithelial ovarian carcinoma.METHODS. This study was a retrospective analysis of 286 consecutive patients with primary epithelial ovarian carcinoma. Inclusion criteria included histopathologically documented International Federation of Gynecology and Obstetrics (FIGO) Stage IC-IV epithelial ovarian carcinoma; first-line treatment with paclitaxel and a platinum analog; intravenous second-line treatment with topotecan 1.0 mg/m(2)/day for 5 days, every 3 weeks or paclitaxel (175 mg/m(2)) and carboplatin (AUC 5), every 3 weeks.RESULTS. One hundred two patients fulfilled the inclusion criteria receiving topotecan (n = 57) or paclitaxel-carboplatin (n = 45) because of refractory or recurrent disease. The patients' age at start of second-line treatment in the younger (n = 68) and the elderly (n = 34) group were median 54.0 years (range, 34.7-64.3) and 69.5 years (range, 65.1-77.2), respectively. In the patient group aged younger than 65 years, initial performance status was more favorable than in patients aged older than 65 years (P = 0.007) whereas the groups were similar in relation to other potential prognostic factors (P > 0.05). For patients aged younger than 65 years, the overall response rate of 50% (95% confidence interval [CI], 37-63%) was similar to the response rate of 44% (95% Cl, 27-62%) in patients aged older than 65 years (P = 0.29). The overall survival from the first day of second-line treatment in patients aged younger and older than 65 years were median 13.3+ months (range, 1.2-38.3+) and 11.8+ months (range, 2.0-41.0+), respectively (P = 0.25). In a multivariate Cox analysis, performance status at time of first-line treatment (0 vs.1-2; P = 0.013; hazard ratio [HR], 2.12), performance status at time of second-line treatment (0 vs. 1-2; P = 0.004; HR, 2.47), and response to second-line treatment (CR + PR vs. NC + PD; P < 0.001; HR, 4.38) were found to be independent significant factors for overall survival whereas age (younger than 65 years vs. older than 65 years) yielded no independent information (P = 0.90). No differences in the rate of postponement of treatment, neutropenia Grade 4, trombocytopenia Grade 3-4, nor hypersensitivity reaction to either cytostatic agent between older and younger patients were noticed (P > 0.05).CONCLUSIONS. Modality of second-line treatment of epithelial ovarian carcinoma should be determined more by assessment of performance status than age per se. Second-line treatment with topotecan or paclitaxel-carboplatin can be safely administered in the aged.