Advanced Epithelial Ovarian Cancer: Have We Really Improved Care for Patients Aged 70 Years and Older? A 20-year Registry-based Study
Advanced epithelial ovarian cancer (aEOC, International Federation of Gynecology and Obstetrics(FIGO) stages IIIC-IV) is the most frequently diagnosed and lethal form of ovarian cancer. The aim of this study was to evaluate net survival (NS) over time and the differences between younger (<70 years) and older (≥70 years) patients (OPs). All patients with aEOC diagnosed in the French department of Côte d'Or between 01 January 1998 and 31 December 2018 were included. Two-year and 5-year NS were calculated for the two age groups over three periods: 1998 to 2004 (T1), 2005 to 2011 (T2), and 2012 to 2018 (T3). A total of 392 patients were included, of whom 154 (39.3%) were aged ≥70 years. Surgery-based treatment was used less frequently in OPs (58.15% vs 83.41%, P < 0.0001) and decreased over time, notably in OPs (74.2% at T1 vs 34.8% at T3, P < 0.001). There was a clear increase in chemotherapy alone at T3 vs T1 in OPs (odds ratio = 8.14, 95% confidence interval [CI]: [2.49-26.58], P < 0.001). The 5-year NS was lower in OPs (23.3%, 95% CI: [17.1-31.8] vs 44.6%, 95% CI: [38.7%-51.6%], P < 0.001) over the 20-year period. The only significant difference in NS between patients aged ≥70 years and <70 years was observed during T3, 17.9% (95% CI: [10.9-29.5]) vs 42.9% (95% CI: [33.8-54.4], P < 0.001) for 5-year NS. NS for aEOC was lower in women aged ≥70 years, especially from 2012 to 2018. Nonoptimal treatment was also more frequent in the older age group.