Abstract
BackgroundPrimary debulking surgery (PDS) is the main treatment for patients with advanced ovarian cancer, and neoadjuvant chemotherapy (NACT) is for bulky stage III-IV patients who are poor surgical candidates and/or for whom there is a low likelihood of optimal cytoreduction. NACT can increase the rate of complete cytoreduction, but this advantage has not translated to an improvement in survival. Therefore, we aimed to identify factors associated with the survival of patients who received NACT followed by interval debulking surgery (IDS).MethodsA retrospective study was conducted in FIGO stage IIIC-IV epithelial ovarian cancer patients who underwent PDS or IDS in our center between January 1st, 2013, and December 31st, 2018.ResultsA total of 273 cases were included, of whom 20 were lost to follow-up. Progression-free survival (PFS) and overall survival (OS) of the IDS and PDS groups were found to be similar, although the proportion of patients in stage IV and serum carbohydrate antigen 125 (CA125) levels before treatment in the IDS group were significantly higher than that in the PDS group. Body mass index (BMI), CA125 level before IDS, residual disease after surgery, and the interval between preoperative and postoperative chemotherapy were all found to be independent prognostic factors for PFS; FIGO stage, residual disease after surgery, and CA125 level before IDS were independent prognostic factors for OS. We found that PFS and OS were both significantly longer in patients with normal CA125 levels before IDS and when the interval between preoperative and postoperative chemotherapy was < 35.5 days (IDS-3 group) than for patients in the PDS group.ConclusionsThe results suggested the importance of timely IDS and postoperative chemotherapy and potentially allowed the identification of patients who would benefit the most from NACT. Normal CA125 levels before IDS and an interval between preoperative and postoperative chemotherapy no longer than 5 weeks were associated with improved prognosis in advanced ovarian cancer patients.
Highlights
Primary debulking surgery (PDS) is the main treatment for patients with advanced ovarian cancer, and neoadjuvant chemotherapy (NACT) is for bulky stage III-IV patients who are poor surgical candidates and/or for whom there is a low likelihood of optimal cytoreduction
Three prospective randomized controlled trials concluded that the prognosis of patients treated with NACT-interval debulking surgery (IDS) was noninferior to that of patients treated with PDS [7,8,9], but a meta-analysis indicated that PDS yielded better survival than NACT-IDS [6]
We found that lower Body mass index (BMI), normal carbohydrate antigen 125 (CA125) levels before IDS, R0 cytoreduction, and a shorter interval between preoperative and postoperative chemotherapy were independent factors associated with better Progression-free survival (PFS); earlier stage, R0 cytoreduction and normal CA125 levels before IDS were independent factors associated with better overall survival (OS)
Summary
Primary debulking surgery (PDS) is the main treatment for patients with advanced ovarian cancer, and neoadjuvant chemotherapy (NACT) is for bulky stage III-IV patients who are poor surgical candidates and/or for whom there is a low likelihood of optimal cytoreduction. There are two main treatments for advanced ovarian cancer: (1) primary debulking surgery (PDS) + postoperative chemotherapy and (2) neoadjuvant chemotherapy (NACT) + interval debulking surgery (IDS) + postoperative chemotherapy The former is the standard treatment, and the latter is for bulky stage IIIIV patients who are poor surgical candidates and/or for whom there is a low likelihood of optimal cytoreduction. It is easier to achieve R0 cytoreduction with a lower incidence of complications by treating patients with NACT-IDS than by treating patients with PDS [2,3,4,5,6] This advantage has not translated to an improvement in survival. This study aimed to identify prognostic factors associated with acceptable NACT-IDS outcomes, and we expected that controlling certain factors would improve the prognosis
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