With the population aging, development of safe and effective treatments for elderly patients with cancer is needed. Although old age is considered a poor prognostic factor, this is not only because of the patient’s disease condition or response to treatment, but also because of treatment strategy and intensity. The purpose of this study was to clarify the influence of age on treatment and prognosis in patients with cervical cancer.
Women with stage Ib–IV cervical cancer treated at our institution between 1997 and 2014 were retrospectively analyzed. Patients were stratified by age into groups for analysis, <65 years and ≥65 years. Categorical variables were compared using chi-squared and Fisher’s exact tests. Survival analyses were performed using the Kaplan–Meier method, and comparisons were made using the log-rank test. Subsequently, Cox proportional hazards models were developed to find independent prognostic factors.
Of 959 patients included in our study, 247 were ≥65 and 712 were <65 years of age. Elderly patients tended to be at a more advanced stage than younger patients (p < 0.001). Elderly patients more commonly had comorbidities. More received standard treatment in the younger patient group at any disease stage than in the elderly patient group (p < 0.001). Similar rates of adverse effects caused by surgery or radiotherapy were seen in patients from both groups. Although overall survival was statistically shorter in elderly patients (74.7 vs. 57.1%, p < 0.001), there was no significant difference in disease-specific survival for patients treated only with standard treatment. In multivariate analyses, clinical stage, histological type, treatment intensity, and primary surgery remained independent prognostic factors. Age was not an independent prognostic factor.
The influence of age on prognosis in patients with cervical cancer was less than we expected. Elderly patients might have better outcomes depending on the type of standard treatment they receive. The appropriate modality and intensity of treatment should be based on the patient’s general condition and background.
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Homepage provided by Statistics Bureau, Ministry of Internal Affairs and Communications , 2017. (http://www.stat.go.jp/data/topics/topi721.htm).
Cancer Registry and Statistics. Cancer Information Service, National Cancer Center, Japan, 2016.
- NCCN clinical practice guidelines in oncology, version 2.2017
- Significance of age and comorbidity on treatment modality, treatment adherence, and prognosis in elderly ovarian cancer patients.Gynecol Oncol. 2012; 127: 367-374
- Ovarian cancer in the elderly: impact of surgery on morbidity and survival.Eur J Surg Oncol. 2011; 37: 537-542
- Evidence-based guidelines for treatment of cervical cancer in Japan.Jpnan Society Gynecologic Oncology (JSGO), 2015 (2011 edition)
- Patterns of care and treatment outcomes for elderly women with cervical cancer.Cancer. 2012; 118: 3618-3626
- The effects of age on treatment and outcomes in women with stages IB1–IIB cervical cancer.J Geriat Oncol. 2013; 4: 374-381
- Outcome and toxicity of radical radiotherapy or concurrent chemotherapy or for elderly cervical cancer women.BMC Cancer. 2017; 17: 510
- Patterns of care and outcome in elderly patients with cervical cancer: a retrospective analysis.Int J Gerontol. 2011; 5: 89-93
- Carcinoma of the cervix in elderly patients treated with radiotherapy: patterns of care and treatment outcome.J Gynecol Oncol. 2016; 27: e59
- Gynecologic cancer outcomes in the elderly poor: a population-based study.Cancer. 2015; 121: 3591-3599
- Cervical cancer (PDQ): treatment, health professional version.National Cancer Institute, 2018
- Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90-01.J Clin Oncol. 2004; 22: 872-880
- Chemoradiotherapy for cervical cancer meta-analysis collaboration. Reducing uncertainties about the effects of chemoradiotherapy for cervical cancer: a systematic review and meta-analysis of individual patient data from 18 randomized trials.J Clin Oncol. 2008; 26: 5802-5812
Published online: June 17, 2018
Accepted: June 14, 2018
Received: March 28, 2018
© 2018 Elsevier B.V. All rights reserved.