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. 2025 Oct;312(4):1163-1173.
doi: 10.1007/s00404-025-08095-3. Epub 2025 Jul 11.

Earlier is not always better: Optimal time to initiate adjuvant chemotherapy after surgery for ovarian cancer

Philipp Meyer-Wilmes  1 , Lieven Nils Kennes  2 , Atanas Ignatov  3 , Franziska Goetz  1 , Julia Wittenborn  1 , Elmar Stickeler  1 , Svetlana Nikolayevna Tchaikovski  4   5
Affiliations

Earlier is not always better: Optimal time to initiate adjuvant chemotherapy after surgery for ovarian cancer

Philipp Meyer-Wilmes et al. Arch Gynecol Obstet. 2025 Oct.

Abstract

Objective: Tumor resection followed by adjuvant chemotherapy constitutes the cornerstone of ovarian cancer (OC) treatment. This study aimed to evaluate the impact of the time to chemotherapy (TTC) after primary surgery on the survival outcomes of patients with OC.

Methods: Patients with OC at any stage who underwent primary surgery followed by adjuvant chemotherapy between 2000 and 2021 were included in the analysis. Data were obtained from the Cancer Registries of Aachen and nine hospitals in Saxony-Anhalt. Patients were stratified into three subgroups based on the timing of chemotherapy initiation: early (≤ 21 days), intermediate (22-35 days) and late (> 35-180 days). The impact of TTC on progression-free survival (PFS) and overall survival (OS) was assessed using multivariate Cox proportional hazard models, both in complete case analysis and with multivariate imputation by chained equations to account for missing data.

Results: A total of 1699 patients with OC (mean age: 61.4 ± 12 years) started adjuvant chemotherapy 32.2 ± 24.6 days after surgery. For OS, the optimal TTC was identified at 26 days post-surgery. Compared with the intermediate group, both earlier and later initiation of chemotherapy were associated with worsened OS (Hazard Ratio (HR) = 1.34, 95%CI 1.23-1.60, p < 0.05 and HR = 1.38 95%CI 1.14 -1.68; p < 0.001, respectively).

Conclusion: The optimal timing for initiating adjuvant chemotherapy appears to be between 22 and 35 days after primary surgery for ovarian cancer. Remarkably, an earlier start of chemotherapy did not confer a survival advantage, possibly due to the need for adequate recovery after surgery.

Keywords: Gynecologic cancer; Real world data; Surgery; Survival; Time to chemotherapy.

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Conflict of interest statement

Declarations. Conflict of interests: The authors declare no competing interests. Ethical approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki. Approval through the ethical committee and informed consent were waived by the Medical Faculty of Otto-von Guericke University of Magdeburg, Germany, owing to the retrospective design of the study and the use of anonymized data from the cancer registry. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Flow chart of the patient selection
Fig. 2
Fig. 2
Association between time to chemotherapy and mortality in ovarian cancer. This figure illustrates the relative hazard of death (y-axis) as a function of the time to chemotherapy initiation in days (x-axis). The y-axis represents the hazard ratio, which quantifies the instantaneous risk of death at each time point relative to a baseline hazard set to 1.0. Values above 1.0 indicate an increased risk of death compared to the reference. Values < 1.0 indicated a reduced risk of death. The minimum hazard was observed when chemotherapy was initiated 26 days postoperatively, suggesting this as a potential optimal time point for initiation of adjuvant chemotherapy. Shaded area illustrates 95%-confidence bounds
Fig. 3
Fig. 3
Survival in subgroups stratified by time to chemotherapy. Overall survival (A) and progression-free survival (B) in the three subgroups according to the time to initiation of adjuvant chemotherapy (TTC). Dashed lines represent the early group (≤ 21 days); solid lines indicate the intermediate group (22–35 days) and dotted lines correspond to the late group (36–180 days)
See this image and copyright information in PMC

References

    1. Webb PM, Jordan SJ (2017) Epidemiology of epithelial ovarian cancer. Best Pract Res Clin Obstet Gynaecol [Internet]. 41:3–14 - DOI - PubMed
    1. Robert Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. Krebs in Deutschland 2011/2012, 10. Ausgabe. 2015 [Internet]. Available from: http://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutsch... eutschland_node.html.
    1. Lheureux S, Gourley C, Vergote I, Oza AM (2019) Epithelial ovarian cancer. Lancet (London, England) [Internet] 393(10177):1240–1253 - DOI - PubMed
    1. Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR et al (2006) What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol 103(2):559–564 - DOI - PubMed
    1. Benedetti Panici P, Di Donato V, Fischetti M, Casorelli A, Perniola G, Musella A et al (2015) Predictors of postoperative morbidity after cytoreduction for advanced ovarian cancer: analysis and management of complications in upper abdominal surgery. Gynecol Oncol [Internet]. 137(3):406–411 - DOI - PubMed

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