Leave it in the past - Primary treatment modality for high-grade epithelial ovarian cancer is not associated with secondary cytoreduction outcomes: A Memorial Sloan Kettering Cancer Center Team Ovary study Journal Article
| Authors: | Sia, T. Y.; Manning-Geist, B. L.; Ehmann, S.; Lavery, J. A.; Luardo, C.; Praiss, A.; Iasonos, A.; Sonoda, Y.; Grisham, R. N.; Liu, Y. L.; Broach, V.; Zivanovic, O.; Long Roche, K.; Gardner, G. J.; Chi, D. S. |
| Article Title: | Leave it in the past - Primary treatment modality for high-grade epithelial ovarian cancer is not associated with secondary cytoreduction outcomes: A Memorial Sloan Kettering Cancer Center Team Ovary study |
| Abstract: | Objectives: To compare outcomes of patients with high-grade epithelial ovarian cancer (EOC) who underwent secondary cytoreduction surgery (SCS) after up-front treatment with neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) versus primary debulking surgery (PDS). Methods: Patients with high-grade EOC who underwent SCS from 2/1/2004–10/31/2021 were classified by up-front treatment. Clinical and treatment characteristics were compared between cohorts. Progression-free survival (PFS2) and overall survival (OS2) following SCS were compared using a Cox model adjusted for stage, age at SCS, and number of years between end of chemotherapy and SCS. Results: Of 374 patients, 62 (17%) underwent NACT-IDS and 312 (83%) PDS. Justification for NACT was disease extent (n = 57, 92%), comorbidities (n = 3, 5%), and thromboembolism (n = 2, 3%). The NACT-IDS cohort had a higher median age at SCS (64 years [IQR: 56–70] vs 59 years [IQR: 53–66]; P =.03), higher proportion of stage III/IV disease (100% vs 81%; P <.001), and shorter median interval between end of chemotherapy and SCS (1.5 years [IQR: 1.1–2.3] vs 1.9 years [IQR: 1.3–3.1]; P =.01). Achievement of complete gross resection at SCS did not differ between NACT-IDS and PDS (84% vs 88%; P =.18). PFS2 (HR: 1.19, 95% CI: 0.83–1.71) and OS2 (HR: 0.96, 95% CI: 0.57–1.63) did not vary by primary treatment modality after adjusting for clinically relevant covariates. Conclusions: Despite more extensive disease at presentation, patients with high-grade EOC who recur after NACT-IDS seem to have similar surgical and survival outcomes after SCS compared to patients who recur after PDS, suggesting that prior NACT-IDS should not preclude SCS. © 2023 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; controlled study; human tissue; aged; major clinical study; overall survival; clinical feature; patient selection; systemic therapy; postoperative care; cancer staging; follow up; laparoscopy; laparotomy; preoperative evaluation; sensitivity analysis; cytoreductive surgery; progression free survival; antineoplastic metal complex; cohort analysis; chemosensitivity; medical record review; retrospective study; cancer therapy; histology; minimal residual disease; thromboembolism; reoperation; comorbidity; ovary carcinoma; neoadjuvant chemotherapy; ca 125 antigen; epithelial ovarian cancer; outcomes; germline mutation; primary debulking surgery; interval debulking surgery; maintenance chemotherapy; human; female; article; robot assisted surgery; positron emission tomography-computed tomography; ecog performance status; secondary cytoreduction surgery |
| Journal Title: | Gynecologic Oncology |
| Volume: | 176 |
| ISSN: | 0090-8258 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2023-09-01 |
| Start Page: | 69 |
| End Page: | 75 |
| Language: | English |
| DOI: | 10.1016/j.ygyno.2023.07.006 |
| PUBMED: | 37454565 |
| PROVIDER: | scopus |
| PMCID: | PMC10530358 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Dennis S. Chi -- Source: Scopus |
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