Treatment Patterns and Survival in Older Patients with FIGO Stage IIB–IV Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Carcinomas

Background: Older adults with epithelial ovarian cancer (EOC) are underrepresented in prospective studies, and treatment selection is influenced by frailty, comorbidity, disease burden, and clinician assessment. We evaluated treatment patterns, operative outcomes, and survival associations in a single-center cohort of patients aged 70 years or older with FIGO stage IIB–IV EOC-spectrum malignancies. Methods: We screened 122 patients treated between January 2010 and December 2023 and included 97 patients after exclusions. The primary outcomes were progression-free survival (PFS) and overall survival (OS). PFS excluded seven patients recorded as receiving no treatment, whereas OS included all 97 patients. Kaplan–Meier methods were used to estimate PFS and OS, and overall log-rank tests were used to compare survival across age groups. Exploratory Cox proportional-hazards models included age, FIGO stage, and diagnosis era; post-baseline treatment completion and maintenance therapies were not included as fixed covariates because of potential guarantee-time bias and incomplete exposure dates. Results: The cohort comprised 44 patients aged 70–74 years, 38 aged 75–79 years, and 15 aged 80 years or older. Recorded treatment groups were primary debulking surgery (PDS; n = 46), NACT followed by recorded interval debulking surgery (NACT + IDS; n = 22), chemotherapy alone (n = 22), and no treatment (n = 7). Among the 90 patients in the PFS population, 61 experienced an event; among all 97 patients, 36 died. Median PFS was 22.0 months (95% CI, 16.0–24.0) and median OS was 51.5 months (95% CI, 38.0–not reached). Age-group log-rank p values were 0.684 for PFS and 0.248 for OS. The baseline Cox models were exploratory and showed no statistically significant association between age and PFS or OS after adjustment for FIGO stage and diagnosis era. Conclusions: This retrospective cohort does not establish that age, surgery, treatment completion, or maintenance therapy causes a survival difference. Survival estimates among patients aged 80 years or older were imprecise. Treatment comparisons should be interpreted as selected-cohort associations, and prospective studies incorporating validated geriatric, comorbidity, molecular, and time-dependent treatment information are needed.