Abstract
Background: The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Outcome measures included progression-free survival (PFS), overall survival (OS), and surgical complications. Methods: This was a retrospective, multicenter cohort study in nine referral centers of France between January 2000 and June 2017. OS analysis using the multivariate Cox regression model was performed. PFS and surgery-related morbidity were analyzed. Results: Of the 255 patients included, 100 were in Group 1 and 155 in Group 2. Patient majority was, on average, younger and less comorbid, with predominant R0 surgery in Group 2. Dindo–Clavien score was similar between the two groups (p = 0.15). Median OS was 26.8 months in Group 2 and 27.6 months in Group 1. SL was not statistically significant on OS (p = 0.7). Median PFS was 18.3 months in Group 2 and 16.6 months in Group 1. SL had positive impact on PFS (p = 0.005). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1).
Highlights
Ovarian cancer is the eighth leading cause of cancer in women
Analysis was performed of the medical records of all patients with histologically confirmed advanced epithelial ovarian cancer of Stages III or IV according to the Federation of Gynecology and Obstetrics (FIGO) classification with serous subtype, diagnosed between January 2000 and June 2017
Patients with initially inoperable advanced serous-subtype ovarian cancer who had interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) had no significant difference in overall survival (OS), but had improvement in progression-free survival (PFS) at five years between patients who underwent or not systematic pelvic and paraaortic lymphadenectomy whatever the number of removed lymph nodes (p = 0.005), and whatever their status
Summary
Ovarian cancer is the eighth leading cause of cancer in women. In France, it was estimated that 5193 new cases of ovarian cancer occurred during 2018, and the number of deaths was estimated at 3479 [1]. The standard treatment for advanced ovarian cancers is currently based on complete tumor-cytoreduction surgery and chemotherapy based on platinum and taxanes [4]. If upfront debulking is unattainable, interval debulking surgery (IDS) after neoadjuvant chemotherapy (NAC) was accepted as an alternative in women with advanced-stage ovarian cancer [8,9]. The population of interest to this study comprised individuals with advanced-stage ovarian carcinoma who were exposed to neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Those who had not received systematic lymphadenectomy (SL; Group 1) were compared to those who had received SL (Group 2). Conclusions: patients who had received SL (Group 2) had significantly higher PFS regardless of node-positivity status when compared to those who had not received SL (Group 1)
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