Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

• Published in: Journal of gynecologic oncology Vol. 32; no. 6; pp. 1 - 13
• Main Authors: Martina Aida Angeles, Bastien Cabarrou, Antonio Gil-moreno, Asunción Pérez-benavente, Emanuela Spagnolo, Agnieszka Rychlik, Carlos Martínez-gómez, Frédéric Guyon, Ignacio Zapardiel, Denis Querleu, Claire Illac, Federico Migliorelli, Sarah Bétrian, Gwénaël Ferron, Alicia Hernández, Alejandra Martinez
• Format: Journal Article
• Language: Korean
• Published: 대한부인종양학회 01-11-2021
• Subjects: Cytoreduction Surgical Procedures; Fallopian Tube Neoplasms; Neoadjuvant Therapy; Ovarian Neoplasms; Peritoneal Neoplasms; Tumor Burden
• ISSN: 2005-0380

Objective: We sought to evaluate the impact on survival of tumor burden and surgical complexity in relation to the number of cycles of neoadjuvant chemotherapy (NACT) in patients with advanced ovarian cancer (OC) with minimal (CC-1) or no residual disease (CC-0).
Methods: This retrospective study included patients with International Federation of Gynaecology and Obstetrics IIIC-IV stage OC who underwent debulking surgery at 4 high- volume institutions between January 2008 and December 2015. We assessed the overall survival (OS) of primary debulking surgery (PDS group), early interval debulking surgery after 3-4 cycles of NACT (early IDS group) and delayed debulking surgery after 6 cycles (DDS group) with CC-0 or CC-1 according to peritoneal cancer index (PCI) and Aletti score.
Results: Five hundred forty-nine women were included: 175 (31.9%) had PDS, 224 (40.8%) early IDS and 150 (27.3%) DDS. Regardless of Aletti score, median OS after PDS was significantly higher than after early IDS or DDS, but the survival difference was higher in women with an Aletti score < 8. Among patients with PCI ≤10, median OS after PDS was significantly higher than after early IDS or DDS. In women with PCI >10, there were no differences between PDS and early IDS, but DDS was associated with decreased OS.
Conclusion: The benefit of complete PDS compared with NACT was maximal in patients with a low complexity score. In patients with low tumor burden, there was a survival benefit of PDS over early IDS or DDS. In women with high tumor load, DDS impaired the oncological outcome.