Management of the Elderly Patients with High-Grade Serous Ovarian Cancer in the REAL-WORLD Setting

Round 1

Reviewer 1 Report

In the review manuscript entitled ”Management of the elderly patients with high grade serous ovarian cancer in the REAL-WORLD setting” by Liontos M, et al., the authors have studied and analyzed in detail about 735 patients with advanced high grade serous ovarian carcinomas that underwent treatment at their institute from 1995 to 2018. These patients were divided into two groups based on their age with group one including patients age 70 years and above while the second group consists of patients age less than 70 years.

The authors measured patient’s performance status according to ECOG scale performance status. Overall survival and progression free survival were also calculated as part of the survival analysis. Based on their analysis the authors concluded that elderly ovarian cancer patients have worse prognosis and proposed that a comprehensive geriatric assessment should be performed for the optimal treatment of these patients.

The manuscript is methodical, well written and the conclusion drawn are supported by data analysis, therefore, I only have following comments:

Specific comments:

1. There are several studies emphasizing that the ovarian cancer assessment of old patients should not be based only on chronological age but through multidimensional evaluation. How is this study different from already published literature with relatively larger patient datasets with similar conclusions?
2. The authors proposed that suboptimal surgical management is the most important negative prognostic factor for ovarian cancer patients. Can the authors shed more light regarding the optimal surgical approach especially among elderly ovarian cancer patients?

 

 

 

Author Response

"Please see the attachment."

Author Response File: Author Response.docx

Reviewer 2 Report

This is a nice clinical retrospective study.

I suggest the authors include analyse the outcome of chemotherapy (tumour relapse) between elderly patients and younger patients.

The authors collected data from the patients treated in their institution from 1995 and 2018. As they said that genetic counselling and testing for BRCA1/2 mutation should be offered to all new diagnosed patients (the reference they cited was published in 2016). In their result, the authors showed that the genetic testing for gremlin BRCA1/2 mutation was performed in a similar manner, independent of the age of the patients. These low percentage of gBRCA testing (16.1% for age<70 and 10.6% for age>70) may due to the genetic test was not available for the patients who received medical treatment between 1995 and 2015. I suggest the authors analyse the patients' data between 2016-2018 for gBRCA testing. 

Minor: please provide a long form of ECOG-PS (performance status) in the abstract.

Author Response

"Please see the attachment."

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors have already responses my comments. Thank you.