Does age matter? An ovarian cancer cohort from a single, urban, academic institution.
Authors: Holtzman Sharonne , Letchinger Riva , Stoffels Guillaume , McCarthy Lily , Zachem Alexis L , Zeligs Kristen , Blank Stephanie V. 
Published: June 2023

e17599

Background: While it is well established that age of diagnosis impacts survival in patients with certain types of cancer including breast, colon and prostate, this has yet to be explored in ovarian cancer. The aim of this study was to examine age of diagnosis of ovarian cancer in relation to oncologic treatment, prognosis, and surgical outcomes. Methods: All patients diagnosed with ovarian cancer between the dates of January 1, 2014 and December 31, 2022 who underwent surgical staging at a single institution were identified. Clinicopathological and follow-up data were extracted from patient’s medical record. The survival analysis of time from diagnosis to recurrence or death was accomplished using the Kaplan-Meier method, categorical data were analyzed using Fisher’s exact test and continuous data were compared using Wilcoxon-rank sum test. A result was considered statistically significant at the p < 0.05 level of significance. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC). Results: There were 401 patients who were diagnosed with ovarian cancer during our study period, ranging from 22 to 90 years old. In our cohort, 89 patients (22%) were diagnosed at or before 50 years old and 309 (78%) after 50 years old. When compared to older patients, patients aged less than 50 years at diagnosis were less likely to be White (36 vs. 56%, p < 0.0001), more likely to have private insurance (66 vs. 33%, p < 0.0001), less likely to have high grade serous tumors (42 vs. 73%, p < 0.0001), less likely to have disease stage 3 or 4 (44 vs. 72%), and more likely to receive surgery as primary treatment compared to NACT, regardless of stage (88 vs. 61%, p < 0.0001). Post-operative day of discharge was significantly different between early-diagnosis and later-diagnosis groups (p = 0.02). When age at diagnosis was divided into ≤50 years, 51-70 years, and > 70 years groups, there was not enough evidence to conclude that overall survival differed between the three groups (p = 0.17). The younger cohort was found to have significantly longer recurrence-free survival (RFS) compared to older patients (median time to recurrence or death 92 vs. 28 months, p = 0.007). When age at diagnosis was divided into ≤50 years, 51-70 years, and > 70 years groups, patients in the ≤50 years group were found to have significantly longer RFS compared to patients in the 51-70 years group (p = 0.01) and compared to patients in the > 70 years group (p = 0.01). Once adjusting for stage, however, there was no significant association between age of diagnosis and RFS. Conclusions: In our cohort, patients younger or equal to 50 years old were more likely to have surgery as their primary treatment modality regardless of stage and were more likely to be discharged on an earlier day compared to older patients. Patients less or equal to 50 years old were more likely to be diagnosed at an earlier stage and therefore experience overall longer RFS.