Abstract
The aim of this study is to evaluate the effects on survival outcomes of the disease burden before interval debulking surgery (IDS), surgical complexity, and residual disease after IDS in advanced-stage ovarian cancer treated with neoadjuvant chemotherapy (NAC). We reviewed the data of 268 epithelial ovarian cancer patients who had received three or four cycles of NAC and undergone optimal resections through IDS. The Kaplan–Meier method and Cox regression analysis were used to assess the effects of disease burden (peritoneal cancer index (PCI)), degree of complexity of surgery (surgical complexity score/s (SCS)), and extent of residual disease. In no residual disease (R0) patients, those with intermediate/high SCS had shorter progression-free survival (PFS; p = 0.001) and overall survival (OS; p = 0.001) than patients with low SCS. An analysis of a subset of patients with R0 and low PCIs showed those with intermediate/high SCS had worse PFS and OS than patients with low SCS (p = 0.049) and OS (p = 0.037). In multivariate analysis, patients with R0 as a result of intermediate/high SCS fared worse than patients whose R0 was achieved by low SCS (PFS hazard ratio (HR) 1.80, 95% CI 1.05–3.10; OS HR 5.59, 95% CI 1.70–18.39). High PCIs at the time of IDS, high SCS, and residual disease signal poor prognoses for patients treated with NAC.
Highlights
Ovarian cancer is a highly lethal gynecologic malignancy worldwide and usually is diagnosed at only an advanced stage [1]
Patients were categorized according to low (≤6, n = 123) and high (>6, n = 145) peritoneal cancer index (PCI) based on disease burden at the time of interval debulking surgery (IDS)
We evaluated the relationships between disease burden at the time of IDS, SCS, and residual disease after IDS on survival outcomes in advanced-stage ovarian cancer patients treated with neoadjuvant chemotherapy (NAC)
Summary
Ovarian cancer is a highly lethal gynecologic malignancy worldwide and usually is diagnosed at only an advanced stage [1]. Maximal debulking surgery plus adjuvant platinum-based chemotherapy has become the accepted primary treatment for the disease in its advanced stages. Optimal cytoreduction often requires radical procedures to achieve “no gross residual” disease at the time of surgery. Radical procedures to remove all visible disease before administration of chemotherapy has become the norm in many centers [4,5]. Several studies have shown that patients with an initial high disease burden will have a worse prognosis despite optimal resection with aggressive surgery [6,7]. These results suggest that tumor biology is more important than surgical cytoreduction
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