Lise Lecointre1, Michel Velten2, Massimo Lodi3, Ralph Saadeh1, Vincent Lavoué4, Lobna Ouldamer5, Sofiane Bendifallah6, Martin Koskas7, Pierre Adrien Bolze8, Pierre Collinet9, Geoffroy Canlorbe10, Cyril Touboul11, Cyrille Huchon12, Charles Coutant13, Emilie Faller1, Thomas Boisramé1, Justine Gantzer14, Demarchi Martin15, Jean Jacques Baldauf1, Chérif Akladios1, Marcos Ballester16. 1. Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 2. Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 3. Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. Electronic address: massimo.lodi@chru-strasbourg.fr. 4. Department of Gynecologic Surgery, Hôpital Universitaire de Rennes, Rennes, France. 5. Department of Gynecology, Hôpital Universitaire de Tours, Tours, France; INSERM U1069 Université François-Rabelais, Tours, France. 6. Department of Gynaecology and Obstetrics, Hôpital Tenon, AP-HP, Paris, France. 7. Department of Gynecology, Hôpital Bichat, AP-HP, Paris, France. 8. Gynecological Surgery Service, CHU Lyon-Sud, Pierre-Bénite, 69000, Lyon, France. 9. Department of Gynecological Surgery, Hôpital Jeanne De Flandre, CHRU Lille, France. 10. Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP, Paris, France. 11. Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France. 12. Department of Gynecology, Centre Hospitalier de Poissy, Poissy, France. 13. Department of Surgical Oncology, Georges-Francois Leclerc Cancer Center, Dijon, France. 14. Department of Medical Oncology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France. 15. Medical Oncology Department, Centre Paul Strauss, Strasbourg, France. 16. Department of Gynecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France.
Abstract
OBJECTIVE: The purpose of this study was to compare two groups of patients presenting advanced ovarian carcinoma benefiting from neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery: after 3-4 cycles (group 1) or ≥ 5 cycles (group 2), regarding overall survival (OS) and progression-free survival (PFS), complications related to surgery as well as the extent of cytoreduction were assessed. STUDY DESIGN: We conducted a retrospective, multicenter cohort study in nine referral centers of France, reviewing the charts of all patients who underwent NAC between January 2000 and June 2017. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analyzed PFS and surgery-related morbidity. RESULTS: Of 501 patients included, 236 (47.1 %) benefited from ≤ 4 NAC cycles and 265 (52.9 %) from ≥ 5 NAC cycles. Characteristics data were similar in both groups. The rate of achievement of complete surgery was similar in both groups (p = 0.28). Surgical morbidity and postoperative complications showed no significant differences between both groups. The median OS was 54.2 months, 64 months for group 1 and 49.2 months for group 2. The 5-year survival rate was 45.6 % and 27.6 %. This difference was not statistically significant [HR 1.81 (0.89-3.71), p = 0.09]. Five-year PFS was 19.7 % and 11.7 % respectively (p = 0.31). CONCLUSION: In a large series of advanced ovarian cancer, patients receiving late IDS (≥ 5 NAC cycles) seem to show a poorer prognosis than patients operated on earlier. The survival appears to be mainly determined by optimal resection and response to chemotherapy.
OBJECTIVE: The purpose of this study was to compare two groups of patients presenting advanced ovarian carcinoma benefiting from neoadjuvant chemotherapy (NAC) followed by cytoreductive surgery: after 3-4 cycles (group 1) or ≥ 5 cycles (group 2), regarding overall survival (OS) and progression-free survival (PFS), complications related to surgery as well as the extent of cytoreduction were assessed. STUDY DESIGN: We conducted a retrospective, multicenter cohort study in nine referral centers of France, reviewing the charts of all patients who underwent NAC between January 2000 and June 2017. We performed an OS analysis using multivariate Cox regression models adjusted for potential confounders. We also analyzed PFS and surgery-related morbidity. RESULTS: Of 501 patients included, 236 (47.1 %) benefited from ≤ 4 NAC cycles and 265 (52.9 %) from ≥ 5 NAC cycles. Characteristics data were similar in both groups. The rate of achievement of complete surgery was similar in both groups (p = 0.28). Surgical morbidity and postoperative complications showed no significant differences between both groups. The median OS was 54.2 months, 64 months for group 1 and 49.2 months for group 2. The 5-year survival rate was 45.6 % and 27.6 %. This difference was not statistically significant [HR 1.81 (0.89-3.71), p = 0.09]. Five-year PFS was 19.7 % and 11.7 % respectively (p = 0.31). CONCLUSION: In a large series of advanced ovarian cancer, patients receiving late IDS (≥ 5 NAC cycles) seem to show a poorer prognosis than patients operated on earlier. The survival appears to be mainly determined by optimal resection and response to chemotherapy.
Authors: Andrew Bryant; Shaun Hiu; Patience T Kunonga; Ketankumar Gajjar; Dawn Craig; Luke Vale; Brett A Winter-Roach; Ahmed Elattar; Raj Naik Journal: Cochrane Database Syst Rev Date: 2022-09-26