Jinekolojik Malignite Nedeniyle Cerrahi Uygulanan Geriatrik Kadınlarda POSSUM ve P-POSSUM Skorlarını Kullanarak Sağkalım Analizi: Retrospektif Tek Merkezli Çalışma

Abstract

Özet Amaç: Jinekolojik malignitelerin insidansı yaşla birlikte artmaktadır; ancak çok ileri yaşlı kadınlarda cerrahi sonuçlara ilişkin kanıtlar sınırlıdır. Bu çalışma, 75–89 yaş aralığındaki kadınlarda jinekolojik kanser cerrahisi sonrası POSSUM ve P-POSSUM skorlama sistemlerinin prognostik performansını değerlendirmeyi ve ≥90 yaşındaki hastalarla sağkalım sonuçlarını karşılaştırmayı amaçladı. Gereç ve Yöntem: Haziran 2020 ile Nisan 2025 tarihleri arasında Türkiye, Başakşehir Çam ve Sakura Şehir Hastanesi’nde cerrahi uygulanan toplam 178 hasta (153’ü 75–89 yaş, 25’i ≥90 yaş) retrospektif olarak incelendi. POSSUM ve P-POSSUM skorlarını hesaplamak amacıyla klinik, laboratuvar ve operatif veriler toplandı. Birincil sonuç ölçütü genel sağkalım (OS); ikincil sonuç ölçütleri progresyonsuz sağkalım (PFS), 30 günlük komplikasyon oranı ve 30 günlük mortaliteydi. İstatistiksel analizler jamovi 2.5.0 programı ile yapıldı. Gruplar Mann–Whitney U ve ki-kare testleriyle karşılaştırıldı; sağkalım analizleri Kaplan–Meier eğrileri ve log-rank testleri ile değerlendirildi. Bulgular: Medyan BKİ, hemoglobin ve CRP düzeyleri yaşlı ve ileri yaşlı gruplar arasında anlamlı farklılık göstermedi. POSSUM fizyolojik skorları ile öngörülen morbidite/mortalite oranları ileri yaşlı grupta anlamlı derecede daha yüksekti (p < 0.001), ancak operatif skorlar benzerdir. Birinci, üçüncü ve beşinci yıl sağkalım oranları sırasıyla yaşlı hastalarda %77, %68 ve %51; ileri yaşlı hastalarda %93, %76 ve %69 olarak bulundu (p = 0.496). Sağkalım, tümör lokalizasyonuna (p = 0.002) ve histopatolojik alt tipe (p = 0.008) göre farklılık göstermekte olup, over ve seröz karsinomlarda daha kötü sonuçlar izlendi. Sonuç: POSSUM ve P-POSSUM modelleri, çok ileri yaşlı kadınlarda perioperatif riski olduğundan yüksek tahmin etmiştir. Ancak gözlenen sonuçlar daha genç yaşlı hastalarla karşılaştırılabilir bulunmuştur. Kronolojik yaş tek başına cerrahi için kontrendikasyon olarak değerlendirilmemelidir; dikkatle seçilen ≥90 yaş hastalarda anlamlı sağkalım elde edilebilir. Klinik çalışma kaydı: Uygulanabilir değildir. Bu çalışma retrospektif gözlemsel bir araştırmadır.

Keywords

• jinekolojik onkoloji
• geriatrik
• POSSUM
• P-POSSUM
• Perioperatif risk
• sağkalım

Survival Analysis of Geriatric Women Undergoing Surgery for Gynecologic Malignancies Using POSSUM and P-POSSUM Scores: A Retrospective Single-Center Study

Abstract

Abstract Objectives: The incidence of gynecologic malignancies increases with age, yet evidence on surgical outcomes in very elderly women is limited. This study evaluated the prognostic performance of POSSUM and P-POSSUM scoring systems in women aged 75–89 years undergoing surgery for gynecologic cancers and compared survival outcomes with those aged ≥90 years. Methods: A retrospective single-center study was conducted at Başakşehir Çam and Sakura City Hospital, Türkiye, including 178 patients (153 aged 75–89 years; 25 aged ≥90 years) who underwent surgery between June 2020 and April 2025. Clinical, laboratory, and operative data were collected to calculate POSSUM and P-POSSUM scores. Primary outcome was overall survival (OS); secondary outcomes were progression-free survival (PFS), 30-day complications, and 30-day mortality. Statistical analyses were performed using jamovi 2.5.0. Group comparisons employed the Mann–Whitney U and chi-square tests, while survival was analyzed with Kaplan–Meier curves and log-rank tests. Results: Median BMI, hemoglobin, and CRP did not differ between elderly and senior groups. POSSUM physiological scores and predicted morbidity/mortality were significantly higher in seniors (p < 0.001), whereas operative scores were similar. One-, three-, and five-year survival rates were 77%, 68%, and 51% for elderly patients, and 93%, 76%, and 69% for seniors, respectively, with no significant difference (p = 0.496). Survival varied by tumor site (p = 0.002) and histopathological subtype (p = 0.008), with poorer outcomes in ovarian and serous carcinomas. Conclusions: POSSUM and P-POSSUM models overestimated perioperative risks in very elderly women, while observed outcomes were comparable to younger elderly patients. Chronological age alone should not contraindicate surgery; carefully selected women ≥90 years may achieve meaningful survival outcomes. Clinical trial registration: Not applicable. This study is a retrospective observational study. Keywords: gynecologic oncology, elderly, POSSUM, P-POSSUM, perioperative risk, survival

Keywords

• gynecologic oncology
• elderly
• POSSUM
• P-POSSUM
• perioperative risk
• survival

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