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

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

Authors:	Liu, Y. L.; Filippova, O. T.; Zhou, Q.; Iasonos, A.; Chi, D. S.; Zivanovic, O.; Sonoda, Y.; Gardner, G. J.; Broach, V. A.; O'Cearbhaill, R. E.; Konner, J. A.; Aghajanian, C.; Roche, K. L.; Tew, W. P.
Article Title:	Characteristics and survival of ovarian cancer patients treated with neoadjuvant chemotherapy but not undergoing interval debulking surgery
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. Copyright © 2020. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.
Keywords:	survival; neoadjuvant therapy; ovarian cancer; elderly; cytoreduction surgical procedures
Journal Title:	Journal of Gynecologic Oncology
Volume:	31
Issue:	1
ISSN:	2005-0380
Publisher:	Korean Soc Gynecology Oncology & Colposcopy
Date Published:	2020-01-01
Start Page:	e17
Language:	English
DOI:	10.3802/jgo.2020.31.e17
PUBMED:	31833259
PROVIDER:	scopus
PMCID:	PMC6918896
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85076477741&doi=10.3802%2fjgo.2020.31.e17&partnerID=40&md5=4076755196a04a3f86b4e4a071ce55c9
Notes:	Source: Scopus