Cytoreductive surgery resulted in improved survival compared with neoadjuvant chemotherapy in women with advanced epithelial ovarian cancer, according to a retrospective cohort study published in JAMA Oncology.
Researchers noted, however, that the higher prevalence of limited performance status in women who received neoadjuvant chemotherapy may explain the lower survival rate in that group.
“Epithelial ovarian cancer is associated with the highest case–fatality ratio of all gynecologic cancers,” J. Alejandro Rauh-Hain, MD, of the division of gynecologic oncology at Massachusetts General Hospital, Boston, and colleagues wrote. “The role of neoadjuvant chemotherapy in the treatment of epithelial ovarian cancer remains controversial. Exploratory analyses ... revealed that patients with stage IIIC disease and less than 4.5 cm of disease had superior survival when treated with primary cytoreductive surgery, and patients with stage IV disease had better survival when treated with neoadjuvant chemotherapy. Despite the evidence supporting the noninferiority of neoadjuvant chemotherapy, this approach is not accepted by some gynecologic oncologists in the United States.”
Rauh-Hain and colleagues used the National Cancer Data Base to identify 22,962 women aged 70 years and younger who were diagnosed with stage IIIC or IV epithelial ovarian cancer at U.S. care centers between 2003 and 2011. Researchers matched 2,935 patients treated with neoadjuvant chemotherapy to patients who received cytoreductive surgery.
Median age was 56.12 years, and most patients underwent cytoreductive surgery (86.4%, n = 19,836), while 3,126 (13.6%) received neoadjuvant chemotherapy. Median follow-up was 56.3 months (95% CI, 54.5-59.8) in the chemotherapy group and 56.5 months (95% CI, 54.5-59.2) in the surgery group.
Propensity score matching showed superior OS among patients in the surgery group (37.3 months [95% CI, 35.2-38.7] vs. 32.1 months [95% CI, 30.8-34.1]). However, Rauh-Hain and colleagues wrote that “the association of primary cytoreductive therapy and improved survival would not be statistically significant” if the chemotherapy group contained more women with performance statuses of 1 to 2 compared with the surgery group (60% vs. 50%).
“We found that primary cytoreductive therapy was associated with improved survival compared with neoadjuvant chemotherapy in otherwise healthy women 70 years or younger with advanced-stage epithelial ovarian cancer,” Rauh-Hain and colleagues wrote. “Future research should focus on which patients benefit most from primary cytoreductive surgery or neoadjuvant chemotherapy to tailor the treatment of women with advanced-stage epithelial ovarian cancer.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.