A New Paradigm in Managing Advanced Ovarian Cancer: Differentiating Patients Requiring Neoadjuvant Treatment from Primary Cytoreduction.

Francois Kraus,Cyril Abdeddaim,Anne-Sophie Lemaire,Othman Aissaoui,Annick Chevalier,Bertrand Gachon,Fabrice Narducci,Marie-Cécile Le Deley,Delphine Hudry,Houssein El Hajj,Mariem Ben Haj Amor,Eric Leblanc,Dienabou Sylla

doi:10.3390/cancers13194925

Abstract

Simple SummaryThis study evaluates the comparability of patients treated with primary cytoreduction and patients undergoing neoadjuvant chemotherapy for advanced stages high grade serous ovarian carcinoma by comparing the preoperative and postoperative characteristics after a propensity score matching analysis during ten years in a tertiary cancer center.Our study aims to evaluate the comparability of primary debulking surgery (PDS) and neoadjuvant chemotherapy (NACT) patients. This single-center retrospective study includes all patients treated for advanced stages high-grade serous ovarian carcinomas (HGSOC) between 2007 and 2017. Preoperative characteristics and postoperative outcomes were compared after a propensity score matching analysis. Of the 221 patients included, 38% underwent PDS, and 62% received NACT. There was no age difference at diagnosis; however, CA125 levels, PCI score levels, and rates of stage IV were higher in the NACT group. There were no differences concerning the rate and the severity of complications (p = 0.29). The propensity score distribution showed a broad distinction between PDS patients and NACT patients with no significant overlap. Survival analyses demonstrate, after a median follow-up of 66.5 months, an overall survival (OS) of 105.9 and progression-free survival (PFS) of 29.2 months in the PDS group, compared to OS of 52.8 and PFS of 18.9 months in the NACT group. Advanced HGSOC is a heterogeneous population, in which inoperable patients should be differentiated from PDS patients based on many factors, primarily tumor burden.

Highlights

Ovarian carcinoma represents the fifth cause of cancer-related mortality in women
Treatment modalities for advanced high-grade serous ovarian carcinomas (HGSOC) remain a serious subject of debate. They include either complete primary debulking surgery (PDS) or interval debulking surgery (IDS) associated with carboplatin and paclitaxel-based chemotherapy with or without bevacizumab and or targeted treatment is the standard of care for epithelial ovarian cancer (EOC) [12,13]
Assigning patients to either PDS or neoadjuvant chemotherapy (NACT) was based on several criteria that remained unchanged during the study period

Summary

Introduction

Ovarian carcinoma represents the fifth cause of cancer-related mortality in women. Due to its pauci-symptomatology, patients tend to present at advanced disease stages (IIIC and IV), which contributes to the reduced 5 year overall survival (OS) rate (46%) [1,2,3,4]. This was associated with improved 5 year survival for all epithelial ovarian cancer (EOC) stages (42% and 26% for FIGO stages III and IV, respectively) but no improvement in the 10 year OS (24% all stages combined) This reflects a better disease control but no improvement in long-term survival [7,8]. Treatment modalities for advanced high-grade serous ovarian carcinomas (HGSOC) remain a serious subject of debate. They include either complete PDS or interval debulking surgery (IDS) associated with carboplatin and paclitaxel-based chemotherapy with or without bevacizumab and or targeted treatment is the standard of care for EOC [12,13]

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