Potential risk factors associated with prognosis of neoadjuvant chemotherapy followed by interval debulking surgery in stage IIIc-IV high-grade serous ovarian carcinoma patients.

Abstract

No consensus has been achieved on the prognostic factors for patients with advanced stage epithelial ovarian cancer who underwent neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). This study aimed to investigate the prognostic factors for the patients diagnosed as International Federation of Gynecology and Obstetrics stage IIIc-IV high-grade serous ovarian cancer (HG-SOC). A total of 200 patients histologically diagnosed as IIIc-IV stage HG-SOC were retrospectively analyzed. All patients underwent platinum-NAC followed by IDS treatment between January 2003 and December 2013. The potential predictive factors (including preoperative ascites volume, cancer antigen 125 [CA-125] and CA-125 decreasing kinetics, NAC and adjuvant chemotherapy cycle number as well as tumor characteristics) for optimal cytoreduction by IDS and for progression free survival (PFS) and overall survival (OS) were assessed. Optimal cytoreduction by IDS was achieved in 78% of HG-SOC patients who underwent NAC. The median number of NAC cycle was 3 (range 1-8). No ascites regression (P < 0.01, odds ratio [OR] = 2.28, 95% confidence interval [CI]: 1.41-3.69), and worse CA-125 decreasing kinetics (P < 0.01, OR = 2.01, 95% CI: 1.37-2.93) were independent predictive factors for suboptimal cytoreduction by IDS. Multivariate regression analysis revealed that PFS and OS were independently associated with preoperative ascites (P < 0.01, hazard ratio [HR] = 2.13, 95% CI: 1.38-3.28 and P < 0.01, HR = 2.33, 95% CI: 1.27-4.26, respectively) and CA-125 decreasing kinetics (P = 0.01, HR = 1.10, 95% CI: 1.02-1.18 and P < 0.01, HR = 1.22, 95% CI: 1.08-1.37, respectively). PFS of patients who underwent more than four NAC cycles was shorter than those of patients who received four or less number of NAC cycles; however, no difference was observed for OS. Ascites regression and CA-125 decreasing kinetics were independently associated with the optimal cytoreduction rate and survival of patients diagnosed with advanced stage HG-SOC and treated with NAC/IDS.