Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study

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• 作者：Carsten Lindberg Fag枚-Olsen ; Bent Ottesen ; Henrik Kehlet ; Sofie L. Antonsen ; Ib J. Christensen ; Algirdas Markauskas ; Berit J. Mosgaard ; Christian Ottosen ; Charlotte H. Soegaard ; Erik Soegaard-Andersen ; Claus Hoegdall
• 关键词：Ovarian cancer ; Primary debulking surgery ; Neoadjuvant chemotherapy ; Overall survival ; Surgical outcome
• 刊名：Gynecologic Oncology
• 出版年：February, 2014
• 年：2014
• 卷：132
• 期：2
• 页码：292-298
• 全文大小：387 K

文摘

Objective

In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS).

Methods

All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records.

Results

Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT-IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT-IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39-2.35).

Conclusions

No difference in MOS was observed between PDS and NACT-IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT-IDS could be associated with increased risk of death after two years of follow-up.