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Abstract
Introduction/Background High grade serous carcinomas are the most common subtype of ovarian cancer. Mostly the patients diagnosed with advanced stage disease. The main approach for management consists of primary debulking surgery (PDS). However, some patients cannot be good candidates for primary surgery, and neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) emerges as an alternative strategy. In our study, it was aimed to show that both strategies applied in our clinic are similar in terms of effectiveness.
Methodology Our study retrospectively included 151 patients who were treated between January 2014 and May 2021 in Hacettepe University, Gynaecological Oncology Clinic with a diagnosis of advanced stage high-grade serous carcinoma. These patients were divided into two groups by their strategies as 77 patients for PDS and 74 patients for NACT/IDS groups in terms of 1:1 ratio. Two groups were comparatively investigated for patient characteristics, staging, recurrence and survival rates, and follow up outcomes. p<0,05 was considered to be statistically significant.
Results The importance of performance status (p=0,003) and the clinical stage of patients (p=0,001) were shown regarding to patient selection for the appropriate strategy. Direct effect of ‘no residual tumour after surgery’ on overall survival rates was determined by multivariate analysis (HR: 0,57 [95% CI 0,34 – 0,96]; p=0,034). In terms of overall survival (HR: 0,74 [95% CI 0,45 – 1,22]; log rank p=0,234) and progression-free survival (HR: 0,728 [95% CI 0,50 – 1,06]; log rank p=0,083), it was shown that both of strategies were similar for effectiveness. There was no impact of pandemic on strategy selection (p=0,073).
Kaplan meier plots for overall survival (OS): A and progression-free survival (PFS): B 3-years OS: 73% for PDS and 3-years OS: 63% for NACT/IDS groups
Conclusion NACT/IDS and PDS strategy have the same effectiveness, in terms of surgical complications, recurrence and survival rates. However, if it is envisaged that no residual disease after surgery with appropriate patient selection for strategy, PDS strategy can be considered as leading option.