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Ovarian Cancer in Elderly Patients: Patterns of Care and Treatment Outcomes According to Age and Modified Frailty Index
  1. Annamaria Ferrero, MD*,
  2. Luca Fuso, MD*,
  3. Elisa Tripodi, MD*,
  4. Roberta Tana, MD,
  5. Alberto Daniele, MD*,
  6. Valentina Zanfagnin, MD*,
  7. Stefania Perotto, MD* and
  8. Angiolo Gadducci, MD
  1. * Academic Department of Gynaecology and Obstetrics, University of Torino, Mauriziano Hospital, Torino; and
  2. Division of Gynaecology and Obstetrics, Department of Experimental and Clinical Medicine, University of Pisa, Pisa, Italy.
  1. Address correspondence and reprint requests to Annamaria Ferrero, Academic Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati 62, 10128 Torino, Italy. E-mail:{at}


Objective The present study assessed the predictive value of age and Modified Frailty Index (mFI) on the management of primary epithelial ovarian cancer (EOC) patients aged 70 years or older (elderly).

Methods A retrospective multicenter study selected elderly EOC patients treated between 2006 and 2014. Treatments were analyzed according to the following age group categories: (1) 70 to 75 years versus (2) older than 75 years, and mFI of less than 4 (low frailty) versus greater than or equal to 4 (high frailty).

Results Seventy-eight patients were identified (40 in age group 1 and 38 in age group 2). The mFI was greater than or equal to 4 in 23 women. Median age of low frailty and high frailty was not significantly different (75.6 vs 75.3). Comorbidities were equally distributed according to age, whereas diabetes, hypertension, obesity, and chronic renal failure were more frequent in the high-frailty group. Performance status was different only according to mFI. Twenty percent of age group 1 versus 55.3% of age group 2 underwent none or only explorative surgical approach (P = 0.003), whereas surgical approaches were similar in the 2 frailty groups. The rate of postoperative complications was higher in high-frailty patients compared with low-frailty patients (23.5% vs 4.3%; P = 0.03). Chemotherapy was administered to all the patients, a monotherapy regimen to 50% of them. No differences in toxicity were registered, except more hospital recovery in the high-frailty cohort. Median survival time was in favor of younger patients (98 versus 30 months) and less-frailty patients (56 vs 27 months).

Conclusions Elderly EOC patients can receive an adequate treatment, but patients who are older than 75 years can be undertreated, if not adequately selected. The pretreatment assessment of frailty through mFI could be suggested in the surgical and medical management.

  • Ovarian cancer
  • Elderly
  • Frailty

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  • The authors declare no conflicts of interest.