Delay in adjuvant chemotherapy administration for patients with FIGO stage I epithelial ovarian carcinoma is associated with worse survival

Abstract

<h3>Objectives:</h3> Administration of adjuvant chemotherapy within 42 days from surgery is one of the quality measures for ovarian cancer per SGO. The aim of the present study was to evaluate the impact of chemotherapy delay on the survival of patients with FIGO stage I epithelial ovarian carcinoma (EOC). <h3>Methods:</h3> The National Cancer Database (NCDB) was accessed and patients diagnosed between 2004-2015 with pathological stage I EOC without a history of another tumor who received multi-agent chemotherapy with known surgery-chemotherapy interval and had at least one month of follow-up were identified. Overall survival (OS) was compared between patients who received multi-agent chemotherapy 1-6 weeks and 6-12 weeks from staging surgery with the log-rank test following generation of Kaplan-Meier curves. A Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 8549 patients who met the inclusion criteria and received adjuvant chemotherapy at a median 35 days from surgery were identified; 67.7% received adjuvant chemotherapy 1-6 weeks from staging surgery while 32.3% experienced a delay. Patients who experienced a delay were more likely to be older than 65 years (21.8% vs 18%, p<0.001), with comorbidities (18.4% vs 14.9%, p<0.001), be managed in non-academic facilities (57.1% vs 53.2%, p=0.001), have government-issued insurance (32.7% vs 25.6%, p<0.001), stage IA (44.7% vs 40.1%, p<0.001), low-grade tumors (49.2% vs 45.6%, p=0.004), have a prolonged hospital stay (>10 days) (6.2% vs 2.3%, p<0.001) and an unplanned re-admission within 30-days from surgery (4.3% vs 2.7%, p<0.001). They were also less likely to be White (85.3% vs 89%, p<0.001), and undergo lymphadenectomy (80.7% vs 87.2%, p<0.001). Patients who experienced a delay had worse OS compared to those who did not, p<0.001; 5-year OS rates were 85.7% and 89.7% respectively. For patients with high-grade serous tumors, those who experienced a delay had a 5-yr OS of 81.9% compared to 88.6% for those who did not, p<0.001. After controlling for patient age, race, presence of comorbidities, insurance status, tumor histology and grade, performance of lymphadenectomy and substage, chemotherapy delay was associated with a worse survival (HR: 1.27, 95% CI: 1.12, 1.44). <h3>Conclusions:</h3> For patients with early stage EOC administration of adjuvant chemotherapy within 6 weeks from surgery was associated with better survival.