Journal List > J Gynecol Oncol > v.29(4) > 1094722

Lee, Chung, Lee, Nam, Kim, Kim, and Kim: Impact of increased utilization of neoadjuvant chemotherapy on survival in patients with advanced ovarian cancer: experience from a comprehensive cancer center

Abstract

Objective

The choice between primary debulking surgery (PDS) and neoadjuvant chemotherapy (NAC) in advanced ovarian cancer remains controversial. We evaluated NAC use in our center before and after results from a randomized trial were published, with the aim to determine the impact of changes in the neoadjuvant strategy on survival in advanced-stage ovarian cancer.

Methods

We retrospectively investigated the clinical course of 435 patients with ovarian, tubal, or peritoneal carcinoma (International Federation of Gynecology and Obstetrics [FIGO] stage III or IV). According to the period of treatment, we stratified patients into a control group (n=216; diagnosed between 2006 and 2010; 83.8% underwent PDS) and a study group (n=219; diagnosed between 2011 and 2014; 48.9% received NAC followed by interval debulking surgery [IDS]).

Results

There were no between-group differences in age, body mass index, histology findings, or tumor grade. Compared to patients in the control group, those in the study group were more likely to receive NAC followed by IDS as first-line treatment (48.9% vs. 16.2%; p<0.001), cytoreductive surgery to no-residual disease (21.5% vs. 10.2%; p<0.001), or radical surgery (57.5% vs. 35.6%; p<0.001). However, there was no between-group difference in postoperative morbidity. Kaplan-Meier analysis showed no between-group differences in progression-free or overall survival (p=0.449 and 0.952, respectively).

Conclusion

NAC incorporation resulted in increased optimal cytoreduction rates although no significant differences in survival outcomes were noted. NAC is advantageous for patients with high perioperative morbidity or unresectable disease.

References

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Fig. 1.
Change in NAC use between 2006 and 2014. NAC, neoadjuvant chemotherapy; PDS, primary debulking surgery.
jgo-29-e63f1.tif
Fig. 2.
Kaplan-Meier curves of PFS (A) and OS (B) according to time period (2006–2010 vs. 2011–2014). OS, overall survival; PFS, progression-free survival.
jgo-29-e63f2.tif
Table 1.
Patient and clinical characteristics
Characteristics Group 1 (n=216) Group 2 (n=219) p
Age (yr) 56 (22–83) 55 (26–79) 0.779
BMI (kg/m2) 22.9 (16.0–40.3) 22.5 (16.4–34.4) 0.530
FIGO stage     <0.001
 III 152 (70.4) 93 (42.5)  
 IV 64 (29.6) 126 (57.5)  
Tumor grade     0.214
 1 16 (7.4) 11 (5.0)  
 2 72 (33.4) 62 (28.3)  
 3 107 (49.5) 113 (51.6)  
 Not available 21 (9.7) 33 (15.1)  
Histologic type     0.696
 Serous 174 (80.6) 179 (82.1)  
 Endometrioid 10 (4.6) 5 (2.3)  
 Mucinous 14 (6.5) 14 (6.4)  
 Clear cell 9 (4.2) 12 (5.5)  
 Other 9 (4.2) 9 (3.7)  
ASA score     <0.001
 1 128 (59.3) 60 (27.4)  
 2 77 (35.6) 110 (50.2)  
 3 5 (2.3) 42 (19.2)  
 4 0 (0) 1 (0.5)  
 Not available 6 (2.8) 6 (2.7)  
Median CA-125 level (U/mL) 897.1 (8.7–30,008.8) 1,474.1 (12.9–30,000.0) 0.003
NAC     <0.001
 Yes 35 (16.2) 107 (48.9)  
 No 181 (83.8) 112 (51.1)  
Chemotherapy regimen     0.006
 Paclitaxel+carboplatin 156 (72.2) 171 (78.1)  
 Docetaxel+carboplatin 25 (11.6) 36 (16.4)  
 Paclitaxel+carboplatin+bevacizumab 1 (0.5) 3 (1.4)  
 Paclitaxel+cisplatin 2 (0.9) 3 (1.4)  
 IP chemotherapy 28 (13.0) 0 (0)  
 Others 2 (0.9) 2 (0.9)  
 Not available 2 (0.9) 4 (1.8)  
Not available Cycles of total chemotherapy 2 (0.9) 4 (1.8) 0.005
 ≤6 158 (73.1) 132 (60.3)  
 >6 58 (26.9) 87 (39.7)  

Values are presented as median (range) or number (%).

ASA, American Society of Anesthesiologists; BMI, body mass index; CA-125, cancer antigen 125; FIGO, International Federation of Gynecology and Obstetrics; IP, intraperitoneal; NAC, neoadjuvant chemotherapy.

Table 2.
Classification of postoperative outcomes according to the Memorial Sloan-Kettering Cancer Center's surgical secondary events grading system
Variables Group 1 (n=216) Group 2 (n=219) p
Complication grade*     0.068
 0 102 (47.2) 130 (59.4)  
 1 15 (6.9) 9 (4.1)  
 2 79 (36.6) 62 (28.4)  
 3 10 (4.7) 10 (4.6)  
 4 0 (0) 3 (1.4)  
 5 2 (3.7) 1 (0.5)  
 Not available 8 (3.7) 4 (1.8)  
Major complications     0.465
 0–2 196 (90.7) 201 (91.8)  
 3–5 12 (5.6) 14 (6.4)  
 Not available 8 (3.7) 4 (1.8)  
Residual disease     <0.001
 No gross 22 (10.2) 47 (21.5)  
 ≤1.0 cm 94 (43.5) 111 (50.7)  
 >1.0 cm 52 (24.1) 13 (5.9)  
 Not available 48 (22.2) 48 (21.9)  
PDS     <0.001
 No gross 16 (8.8) 17 (15.2)  
 ≤1.0 cm 77 (42.5) 60 (53.6)  
 >1.0 cm 49 (27.1) 8 (7.1)  
 Not available 39 (21.5) 27 (24.1)  
NAC     0.466
 No gross 6 (17.1) 30 (28.0)  
 ≤1.0 cm 17 (48.6) 51 (47.7)  
 >1.0 cm 3 (8.6) 5 (4.7)  
 Not available 9 (25.7) 21 (19.6)  
Radical surgery     <0.001
 None 139 (64.4) 93 (42.5)  
 Any radical surgery 77 (35.6) 126 (57.5)  
Surgical complexity score groups     0.002
 1 1 (0.5) 0 (0)  
 2 207 (95.8) 191 (87.2)  
 3 8 (3.7) 28 (12.8)  

Values are presented as number (%). NAC, neoadjuvant chemotherapy; PDS, primary debulking surgery.

* According to the Memorial Sloan-Kettering Cancer Center's surgical secondary events grading system [16];

Radical surgery included any of following: bowel surgery, cholecystectomy, diaphragm peritonectomy/resection, distal pancreatectomy video-assisted thoracoscopic surgery, splenectomy, liver resection, supraclavicular fossa resection, ureter resection, and others;

According to Aletti et al [17].

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