Evaluation of results of combined treatment in patients with disseminated ovarian cancer

Abstract

Background. According to the modern concept of surgical treatment of ovarian cancer (OC) it is necessary to perform cytoreductive surgery (CRS) without residual tumor in order to achieve more favorable oncological prognoses. However, the possibilities of achieving it with a disseminated process (stages IIIIV) are limited, and therefore, for some patients, neoadjuvant chemotherapy (NACT) is the optimal initial treatment.
 Aim. To compare the duration of progression-free survival (PFS) of patients with advanced OC after treatment, as well as to assess the value of the prognostic nutritional index (PNI) in predicting this outcome.
 Materials and methods. We conducted a retrospective cohort study of 78 patients with stages IIIIV OC, who received combined treatment between January 2016 and March 2020 (54 patients after primary CRS (PCRS)+platinum-based chemotherapy (CT), 24 patients after NACT+interval CRS (ICRS)+postoperative CT. The predictive value of the PNI was calculated.
 Results. The complete PCRS is associated with increased PFS: after complete PCRS 3211.21 months (95% confidence interval CI 10.0953.97); after optimal PCRS 223.46 months (95% CI 15.2128.79); after suboptimal PCRS 147 months (95% CI 0.2827.72). Performing a complete ICRS is associated with decreased PFS compared to PCRS, even if the complete CRS is achieved: after complete ICRS 143.34 months (95% CI 7.4620.54); after optimal ICRS 172.16 months (95% CI 12.7721.23); after suboptimal ICRS 7 months. PNI27.86 correlates with an increased probability of complete PCRS in patients with advanced PCR (AUC 94.3, sensitivity 80%, specificity 91.7%; p0.001).
 Conclusion. Achieving complete PCRS in patients with disseminated OC leads to an improvement in the oncological outcome. The prognostic value of pre-treatment calculation of PNI has been revealed: an increased PNI is associated with more favorable perioperative outcomes. Objective criteria should be developed for a strictly reasoned refusal to carry out the first stage of surgical treatment due to the obviously less favorable prognosis of the tactics of "NACT+ICRS+CT".