J Gynecol Oncol.  2020 Jan;31(1):e17. 10.3802/jgo.2020.31.e17.

Characteristics and survival of ovarian cancer patients treated with neoadjuvant chemotherapy but not undergoing interval debulking surgery

• Liu YL
• Filippova OT
• Zhou Q
• Iasonos A
• Chi DS
• Zivanovic O
• Sonoda Y
• Gardner GJ
• Broach VA
• O'Cearbhaill RE
• Konner JA
• Aghajanian C
• Long Roche K
• Tew WP

• KMID: 2465191
• DOI: http://doi.org/10.3802/jgo.2020.31.e17

Abstract

OBJECTIVE
Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) confers similar outcomes as primary debulking surgery and chemotherapy. Little is known about patients who receive NACT but do not undergo debulking surgery. Our aim was to characterize these patients.
METHODS
We prospectively identified patients with newly diagnosed stage III/IV ovarian cancer treated with NACT from 7/1/15-12/1/17. Fisher exact and Wilcoxon rank-sum tests were used to compare clinical characteristics by surgical status. The Kaplan-Meier method was used to estimate survival outcomes. Log-rank test and Cox proportional hazards model were applied to assess the relationship of covariates to outcome, and time-dependent covariates were applied to variables collected after diagnosis.
RESULTS
Of 224 women who received NACT, 162 (72%) underwent IDS and 62 (28%) did not undergo surgery. The non-surgical group was older (p<0.001), had higher Charlson comorbidity index (CCI; p<0.001), lower albumin levels (p=0.007), lower Karnofsky performance scores (p<0.001), and were more likely to have dose reductions in NACT (p<0.001). Reasons for no surgery included poor response to NACT (39%), death (15%), comorbidities (24%), patient preference (16%), and loss to follow-up (6%). The no surgery group had significantly worse overall survival (OS) than the surgery group (hazard ratio=3.34; 95% confidence interval=1.66-6.72; p<0.001), after adjustment for age, CCI, and dose reductions.
CONCLUSIONS
A significant proportion of women treated with NACT do not undergo IDS, and these women are older, frailer, and have worse OS. More studies are needed to find optimal therapies to maximize outcomes in this high-risk, elderly population.

Keyword

Ovarian Cancer; Neoadjuvant Therapy; Cytoreduction Surgical Procedures; Survival; Elderly

MeSH Terms

Aged
Comorbidity
Cytoreduction Surgical Procedures
Diagnosis
Drug Therapy*
Female
Follow-Up Studies
Humans
Methods
Neoadjuvant Therapy
Ovarian Neoplasms*
Patient Preference
Proportional Hazards Models
Prospective Studies