Advanced Ovarian Cancer Survival Rates Longer After Primary Cytoreductive Surgery Compared With Neoadjuvant Chemotherapy

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Median 5-year overall survival for patients with HGSC was 3.89 after PCS and 2.48 after NACT.
Median 5-year overall survival for patients with HGSC was 3.89 after PCS and 2.48 after NACT.

Primary cytoreductive surgery (PCS) is associated with a longer survival rate compared with neoadjuvant chemotherapy (NACT) in patients with stage IIIC and IV high-grade serous ovarian carcinoma (HGSC), according to a study published in the International Journal of Gynecological Cancer.

Taymaa May, MD, MSc, FRCSC, from the Department of Obstetrics and Gynecology at the University of Toronto, and colleagues, conducted a retrospective cohort analysis to examine patterns of clinical practice in the management of women with advanced HGSC. A total of 852 women between ages 18 and 80 years with International Federation of Gynecology and Obstetrics stage IIIC or IV high-grade serous ovarian, fallopian tube, or primary peritoneal carcinoma from 4 Canadian cancer centers were included.

Patients were categorized into 2 groups: those who underwent PCS followed by adjuvant chemotherapy (PCS group) and those who were treated with NACT and interval cytoreductive surgery (NACT group). The extent of residual disease was based on the diameter of the single largest lesion and categorized as microscopic (0 mm), 1 to 9 mm, and 10 mm or more. 

The study was conducted from January 2007 to December 2013, with the primary end point at 5-year and 7-year overall survival (OS). Survival end point was defined as the date of first treatment for the NACT group or the date of surgery for the PCS group to the date of death from ovarian cancer, death from other cause, lost to follow-up, or last follow-up date.

Of the 852 patients, 357 (42%) received care at Princess Margaret Cancer Center, Toronto; 225 (26%) at Tom Baker Cancer Center, Calgary; 205 (24%) at London Health Science Center, London, ON; and 65 (8%) at Cancer Care Manitoba, Winnipeg. Overall, 449 patients (53%) had primary debulking surgery, and 403 patients (47%) had NACT. Mean age of study patients was 62.1 years. Patients were followed for a mean of 4.1 years.

A total of 72 (8%) of 852 patients had intraoperative complications. Among patients who experienced complications, 28 patients (39% of complications, 3.2% of study patients) had surgery that was considered aggressive. The 30- and 90-day postoperative mortality rates in the PCS cohort were 0.2% and 0.7%, respectively. The 30- and 90-day postoperative mortality rates in the NACT cohort were 0% and 1.2%, respectively.

The median 5-year overall survival was 3.89 for the PCS group and 2.48 in the NACT group. Patients with 0-mm residual had OS of 4.66, compared with 1- to 9-mm residual (OS = 2.80) and 10-mm residual or longer (OS = 2.50). The survival advantage with the extent of surgical cytoreduction was more pronounced with PCS compared with NACT. Patients who had PCS and 1- to 9-mm residual disease had an increased OS when compared with patients who underwent NACT and had 1- to 9-mm residual disease (42.4 vs 23.88 months, respectively).

“In conclusion, our work indicates superior survival in patients who undergo PCS for stage IIIC and IV HGSC,” the authors concluded. “All patients who present with advanced ovarian neoplasms should be referred to a gynecologic oncologist for surgical consultation and not automatically triaged to NACT. When judged feasible, PCS should be the favorable treatment modality.”

Reference

May T, Altman A, McGee J, et al. Examining Survival Outcomes of 852 Women With Advanced Ovarian Cancer: A Multi-institutional Cohort Study. Int J Gynecol Cancer. [Published online ahead of print]. 2018 Apr 4. doi: 10.1097/IGC.0000000000001244

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