Neoadjuvant Chemotherapy Increases R0 Cytoreduction Rate But Does Not Improve Final Outcome in Advanced Epithelial Ovarian Cancer

Abstract

Background

Most epithelial ovarian cancers present in advanced stages. Traditional management is maximum cytoreductive effort followed by platinum–taxane-based chemotherapy. We hypothesized that providing all chemotherapy before surgery will increase the R0 cytoreductive rate and improve prognosis.

Methods

Patients with advanced epithelial ovarian carcinoma [International Federation of Gynecology and Obstetrics (FIGO) stages IIIC and IV without parenchymal metastasis] were included in a comparative study. Group A underwent cytoreductive surgery followed by six cycles of chemotherapy, and group B completed six cycles of preoperative systemic therapy followed by cytoreduction. Demographic, clinical, surgical and pathologic variables were recorded and analyzed. Main outcome end points were progression-free survival (PFS) and overall survival (OS). Complete cytoreduction (R0) was defined as absence of macroscopic disease. Kaplan–Meier curves were constructed for survival analysis and univariate and multivariate analysis was performed. Significance was considered at p < 0.05.

Results

One hundred five patients were included: 42 in group A and 63 in group B. Mean patient age was 56 years (range 32–85 years). There were no significant differences between groups regarding demographic, clinical, surgical or pathologic variables. Surgical morbidity was low and not different between groups and there was no surgical mortality. R0 cytoreduction was obtained in 35.5 versus 64.5% in groups A and B, respectively. Median PFS and OS for the entire cohort were 16.17 and 38 months, respectively. Median PFS were 14.71 and 17.52 months for groups A and B, respectively (p = NS), and OS were 33.59 and 56.4 months for groups A and B, respectively (p = 0.08). Factors significantly associated with decreased survival on multivariate analysis were non-R0 resection (p < 0.001), anemia (Hb < 12 g/dL; p = 0.004) and comorbidities (Charlson score > 2; p = 0.007).

Conclusions

In spite of nearly doubling the rate of complete cytoreduction and reduce severe surgical complications, preoperative chemotherapy does not improve long-term outcome in advanced epithelial ovarian carcinoma.