Predictors of the timing of interval cytoreduction based on the number of cycles of neoadjuvant chemotherapy: a retrospective cohort

Abstract

Objectives: To identify pretreatment clinical variables in ovarian cancer patients undergoing neoadjuvant chemotherapy that predict a delayed interval cytoreductive surgery. Methods: We performed an (institutional review board) IRB-approved retrospective cohort study of advanced-stage ovarian cancer patients at a single, academic, tertiary-referral center. Patients from 2008-2017 with stage III or IV disease who received NACT were included in the study. Patients without a pathologic or cytologic diagnosis, those who did not have treatment records, and those who underwent surgery at another institution were excluded. Patients who underwent interval cytoreduction (IDS) prior to their 4th cycle were compared against those who required 4 or more cycles, as our institution's practice is to undergo cytoreduction after 3 cycles if an optimal debulking is achievable. Chi-square and t-tests were used to compare clinical, radiographic, laboratory, and pathologic variables between the groups. Results: A total of 123 patients were included in the study: 70 (56.9%) patients underwent surgery at <4 cycles and 53 (43.1%) required 4 or more cycles. There was no difference in terms of age, renal function, or primary tumor size at time of diagnosis (Table 1) per number of cycles of NACT prior to IDS for either group. Patients also had a similar decrease in their Ca-125 values as measured by pre-op nadir (283.3 vs 356.6, p=0.69). Patients who underwent interval debulking surgery at <4 cycles were more likely to have a lower Charlson Comorbidity index (5.3 compared to 6.3, p=0.007) and a higher albumin (3.33 compared to 3.00, p=0.007). Not surprisingly, patients with IDS after fewer cycles received their chemotherapy in a shorter mean time period (47.2 vs 103.7 days, p<0.0001). Both groups restarted chemotherapy in a similar time frame after IDS. Conclusions: Patients with increased Charlson Comorbidity Index and a lower baseline albumin were more likely to require 4 or more cycles prior to proceeding with surgery after neoadjuvant chemotherapy for ovarian carcinoma. Ongoing assessment of these variables and other variables prior to initiating NACT may provide guidance regarding anticipated patient outcomes. To identify pretreatment clinical variables in ovarian cancer patients undergoing neoadjuvant chemotherapy that predict a delayed interval cytoreductive surgery. We performed an (institutional review board) IRB-approved retrospective cohort study of advanced-stage ovarian cancer patients at a single, academic, tertiary-referral center. Patients from 2008-2017 with stage III or IV disease who received NACT were included in the study. Patients without a pathologic or cytologic diagnosis, those who did not have treatment records, and those who underwent surgery at another institution were excluded. Patients who underwent interval cytoreduction (IDS) prior to their 4th cycle were compared against those who required 4 or more cycles, as our institution's practice is to undergo cytoreduction after 3 cycles if an optimal debulking is achievable. Chi-square and t-tests were used to compare clinical, radiographic, laboratory, and pathologic variables between the groups. A total of 123 patients were included in the study: 70 (56.9%) patients underwent surgery at <4 cycles and 53 (43.1%) required 4 or more cycles. There was no difference in terms of age, renal function, or primary tumor size at time of diagnosis (Table 1) per number of cycles of NACT prior to IDS for either group. Patients also had a similar decrease in their Ca-125 values as measured by pre-op nadir (283.3 vs 356.6, p=0.69). Patients who underwent interval debulking surgery at <4 cycles were more likely to have a lower Charlson Comorbidity index (5.3 compared to 6.3, p=0.007) and a higher albumin (3.33 compared to 3.00, p=0.007). Not surprisingly, patients with IDS after fewer cycles received their chemotherapy in a shorter mean time period (47.2 vs 103.7 days, p<0.0001). Both groups restarted chemotherapy in a similar time frame after IDS. Patients with increased Charlson Comorbidity Index and a lower baseline albumin were more likely to require 4 or more cycles prior to proceeding with surgery after neoadjuvant chemotherapy for ovarian carcinoma. Ongoing assessment of these variables and other variables prior to initiating NACT may provide guidance regarding anticipated patient outcomes.