Poor Prognostic Factors in Patients Undergoing Surgery After Neoadjuvant Chemotherapy for Ovarian, Tubal, or Peritoneal Cancer

Abstract

Objectives: To investigate the survival-related factors of patients with advanced stage ovarian cancer who underwent debulking surgery after neoadjuvant chemotherapy (NAC).

Methods: Two hundred three patients with stage IIIC to IV ovarian cancer who underwent debulking surgery after NAC between 2002 and 2012 were retrospectively analyzed. Overall survival-associated factors, including the performance of optimal surgery, the timing of NAC cycles, the presence of tumour regression according to the pathology report, and lymphadenectomy, were explored using logistic regression analyses.

Results: Of the 203 patients, 82% (n = 165) underwent optimal surgery. The median follow-up time was 34 months (range 1-124), and the median overall survival was 37.5 months (95% CI 32.6-42.3). The 5-year overall survival rate was 31.3%. Performance of optimal surgery; <4 NAC cycles; presence of tumour regression (either macroscopically, microscopically, or no tumour present) in the omentum according to the pathology report; and lymphadenectomy were found to be statistically significant based on a univariate Cox analysis. Of these factors, >1 cm residual tumour, no tumour regression in the omentum according to the pathology report, and >4 NAC cycles were significant predictors of a poor prognosis based on a multivariate Cox model (hazard ratio [HR] 1.62, 95% CI 1.02-2.59; HR 2.07, 95% CI 1.36-3.17; HR 1.55, 95% CI 1.07-2.34, respectively).

Conclusion: Results of the study support that >1 cm residual tumour at the end of the surgery, the presence of a macroscopic tumour in the omentum, and >4 NAC cycles were independent poor prognostic factors in patients with advanced stage ovarian, tubal, or peritoneal cancer who underwent surgery after NAC.

Keywords: Optimal debulking; interval surgery; overall survival; tumor regression.