Abstract
BackgroundOutcomes of patients with ovarian high-grade serous carcinoma (HGSC) treated with neoadjuvant chemotherapy (NAC) have been widely studied, but there is limited information on the outcomes of patients with non-HGSC. This study aimed to evaluate the outcomes of NAC in non-HGSC patients with advanced-stage ovarian cancer.MethodsWe conducted a retrospective cohort study of patients who underwent NAC for advanced stage non-HGSC between 2002 and 2017 in 17 institutions. Demographics, surgical outcomes, and survival rates were evaluated according to histological subtypes.ResultsA total of 154 patients were included in this study, comprising 20 cases (13.0%) of mucinous adenocarcinoma, 31 cases (20.1%) of endometrioid adenocarcinoma, 28 (18.2%) cases of clear cell carcinoma, 29 (18.8%) cases of low-grade serous carcinoma and 12 cases (7.8%) of carcinosarcoma. Complete remission/partial remission after the third cycle of NAC was achieved in 100 (64.9%) patients and optimal debulking surgery (residual disease ≤1 cm) at interval debulking surgery was achieved in 103 (66.9%) patients. The most common reason for performing NAC was high tumor burden (n = 106, 68.8%). The median progression-free survival (PFS) was 14.3 months and median overall survival (OS) was 52.9 months. In multivariate analyses, mucinous and clear cell carcinoma were negative prognostic factors for both PFS (p = 0.007 and p = 0.017, respectively) and OS (p = 0.002 and p = 0.013, respectively).ConclusionsIn this study, poor survival outcomes were observed in patients with mucinous and clear cell carcinoma undergoing NAC. Different treatment strategies are urgently required to improve survival outcomes for this disease subset.
Highlights
Outcomes of patients with ovarian high-grade serous carcinoma (HGSC) treated with neoadjuvant chemotherapy (NAC) have been widely studied, but there is limited information on the outcomes of patients with non-HGSC
Survival outcomes were significantly poorer in patients with mucinous (PFS, p < 0.001; overall survival (OS), p < 0.001) or clear cell subtype (PFS, p = 0.001; OS, p = 0.002) compared to other subtypes (Fig. 3). In this multicenter retrospective cohort study, we found that non-HGSC had a poor response rate after the third cycle of NAC, low rate of optimal debulking surgery compared to other studies mainly focused on HGSC
In the CHORUS trial [19], HGSC subtype rate was 71% and optimal debulking surgery rate was 73% and in Surgical Complications Related to Primary or Interval Debulking in Ovarian Neoplasms [21], HGSC subtype rate was 98.1%, optimal debulking surgery rate was 90.4%, and complete response/partial response rate according to Response Evaluation Criteria in Solid Tumors (RECIST) was 90.9% in the NAC group
Summary
Outcomes of patients with ovarian high-grade serous carcinoma (HGSC) treated with neoadjuvant chemotherapy (NAC) have been widely studied, but there is limited information on the outcomes of patients with non-HGSC. This study aimed to evaluate the outcomes of NAC in non-HGSC patients with advanced-stage ovarian cancer. Despite an initial response to standard treatment, the overall 5-year survival rate of advanced-stage ovarian cancer is approximately 30% [7]. There has been no significant change in the accepted approach to treatment during the last two decades, which has hampered improvements in long-term survival [8]. In part, this is due to epithelial ovarian cancer being considered as a heterogeneous disease across different histologic subtypes, including high-grade serous carcinoma (HGSC), clear cell carcinoma, endometrioid, mucinous carcinoma, and low-grade serous carcinoma (LGSC) [9]. All ovarian cancers continue to be treated with the same therapeutic strategy regardless of subtype
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