Yonsei Med J.  2020 Nov;61(11):935-941. 10.3349/ymj.2020.61.11.935.

Survival Effects of Cytoreductive Surgery for Refractory Patients after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

• Shin W
• Noh JJ
• Seo SS
• Kang S
• Choi CH
• Park SY
• Kim BG
• Lim MC

• KMID: 2507805
• DOI: http://doi.org/10.3349/ymj.2020.61.11.935

Abstract

Purpose
Salvage second-line chemotherapy is usually recommended for patients with advanced epithelial ovarian cancer (AEOC) who develop progressive disease (PD) after neoadjuvant chemotherapy (NAC). Herein, we investigated the role of cytoreductive surgery (CRS) for such patients.
Materials and Methods
We retrospectively reviewed the medical records of 36 patients with AEOC who developed PD after receiving NAC at two tertiary academic centers with different treatment strategies between 2001 and 2016. Patients who developed PD after NAC were consistently treated with CRS at one hospital (group A; n=13) and second-line chemotherapy at another (group B; n=23). The clinical characteristics and treatment outcomes were compared between the groups.
Results
Overall survival (OS) was longer in group A than in group B (19.4 months vs. 7.9 months; p=0.011). High-grade serous histology was associated with longer OS than non-high-grade serous types. In group A, optimal surgery resection (<1 cm) was achieved after CRS in 6 patients (46%). Multivariate analysis showed that the treatment option was the only independent predictive factor for OS (hazard ratio, 2.30; 95% confidence interval, 1.02–5.17; p=0.044).
Conclusion
CRS may result in a survival benefit even in patients with AEOC who develop PD after NAC.

Keyword

Neoadjuvant therapy; epithelial ovarian cancer; follow-up studies; treatment outcome; cytoreductive surgery