A retrospective clinical study of neoadjuvant chemotherapy for advanced epithelial ovarian cancer

Abstract

Abstract Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy (NACT) and the prognostic factors for advanced epithelial ovarian cancer (EOC). Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan Cancer Hospital between October 2006 and December 2015. The observation (NACT-IDS) group (n = 119) received 1-3 courses of platinum-based NACT, followed by interval debulking surgery (IDS) and 6-8 courses of postoperative chemotherapy. The control group underwent primary debulking surgery (PDS) (n = 122) followed by 6-8 courses of postoperative chemotherapy. We analyzed the general conditions of the operations and the survival of both groups. Results Operating time, intraoperative blood loss and postoperative hospitalization were significantly lower in the NACT-IDS group (P < 0.05). The rate of optimal cytoreductive surgery was significantly higher in the NACT-IDS group (P < 0.05). A visible residual lesion was observed in 49 (41.18%) and 48 (40%) cases in the NACT-IDS and PDS groups, respectively, which were not significantly different (P > 0.05). The percentage of International Federation of Gynecology and Obstetrics (FIGO) stage IV tumors and the recurrence rates were significantly higher in the NACT-IDS group (P < 0.05). The mortality rates were 45.19% (47/104) and 35.19% (38/108) in the NACT-IDS and PDS groups, respectively (P > 0.05). Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups, respectively (P > 0.05). Overall survival (OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACT-IDS and PDS groups, respectively (P > 0.05). Optimal cytoreductive surgery with or without residual lesion was an independent influencing factor for advanced EOC in multivariate analysis. OS of patients treated with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses. Conclusion NACT could improve the intra- and postoperative conditions in advanced EOC patients. Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group, the prognosis was similar in both the NACT-IDS and PDS groups, suggesting that NACT improves the clinical outcome of advanced EOC. Optimal cytoreductive surgery with no residual lesion is a long-term protective factor in advanced EOC. At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively improves the OS.