Treatment and outcome of elderly patients with presumed early ovarian cancer in Germany: real-world observations from the quality-assurance program of the AGO Study Group.

OBJECTIVE

This study investigates treatment quality and survival outcomes in elderly patients (≥75 years) with early-stage (International Federation of Gynecology and Obstetrics stage I/II) epithelial ovarian cancer documented in the German national quality-assurance program. It examines associations between surgical and systemic treatment quality and disease-free and overall survival.

METHODS

Patients with a first diagnosis of ovarian cancer during the third quarter of 2012, 2016, and 2021 were documented. Surgical quality was defined as optimal when no more than one required staging procedure was omitted and sub-optimal when two or more procedures were missing. Chemotherapy quality was considered optimal when aligned with national guidelines. Overall treatment quality was classified as optimal, mixed, or sub-optimal according to surgical and chemotherapy quality.

RESULTS

A total of 228 elderly patients with presumed early-stage epithelial ovarian cancer were included. Among them, 24.6% received both optimal surgery and optimal chemotherapy, 10.1% received optimal surgery with sub-optimal chemotherapy, 25.4% received sub-optimal surgery with optimal chemotherapy, and 39.9% received sub-optimal treatment in both modalities, with marked differences in age, Eastern Cooperative Oncology Group performance status, and comorbidity burden across treatment groups. At 24 months, 64% (95% confidence interval, 58% to 71%) of elderly patients remained disease-free. Within the elderly cohort, 24-month disease-free and overall survival were 90% (95% confidence interval, 82% to 99%) and 98% (95% confidence interval, 94% to 100%) with optimal surgery and chemotherapy, 68% (95% confidence interval, 56% to 81%) and 79% (95% confidence interval, 68% to 90%) with sub-optimal surgery and optimal chemotherapy, and 49% (95% confidence interval, 32% to 76%) and 62% (95% confidence interval, 45% to 87%) with optimal surgery and sub-optimal chemotherapy.

CONCLUSIONS

In elderly patients with assumed early-stage ovarian cancer, guideline-concordant surgery and chemotherapy showed deficits that were associated with unfavorable outcomes. Chemotherapy quality showed a strong association with outcome, underscoring the need to optimize evidence-based treatment in elderly patients. Nonetheless, these findings are associative only, given possible selection of fitter patients and treatment of occult advanced disease in surgically under-staged patients.