Introduction/Background Complete primary debulking surgery (PDS) is the mainstay of treatment for advanced ovarian cancer. However, three randomized trials have demonstrated non-inferiority survival outcome of neoadjuvant chemotherapy followed by interval debulking surgery (IDS). It is widely accepted that NACT is the preferred approach for patients with poor medical performance or with unresectable disease. Best treatment strategy for patients with minimal residual disease at PDS remains under debate. Aim of this study is to evaluate if patients with minimal residual disease of less than 2.5 mm (CC-1)at the time of PDS have similar oncologic outcome from patients with complete macroscopic resection at the time of IDS.
Methodology A retrospective multi-centric study was designed collecting data from patients treated of advanced ovarian cancer with IIIC-IV FIGO stage and CC-0 or CC1 residual disease from January 2008 to December 2015. Patients underwent PDS nor IDS/DDS after 3–4 cycles or 6 of neoadjuvant chemotherapy (NACT). Overall survival (OS) and disease-free survival (DFS) were assessed based in surveillance follow-up to 60 months.
Results 549 patients were included. PDS was performed in 175 patients(31.9%) while 374(68,1%) underwent IDS. 18 of PDS patients had a CC-1 after surgery and 324 of IDS patients had a CC-0 result. Overall median DFS and OS were 19.4 months [95%CI=18.0–20.6] and 68.1 months [95%CI=62.9–73.3], respectively. Univariable analysis revealed no statistical differences in either OS nor DFS between PDS/CC-1 group and IDS/CC-0 group[OS: HR 95% CI=0.54–1.82, p-value=0.9687][DFS:HR 95% CI=0.52–1.43,p-value= 0.5608]. In multivariable analysis PCI score > 10 and surgical complexity were statistically significative for DFS, but only surgical complexity was associated with OS.
Conclusion There are no differences between PDS/CC1 and IDS/CC0 when compared in terms of OS or DFS. PDS can be considered when complete or minimal residual disease can be obtained.
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