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  • 2022-RA-1387-ESGO Patients with minimal residual disease at upfront debulking surgery have similar survival outcome than patients with complete cytorreduction after neoadjuvant chemotherapy

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Ovarian cancer
2022-RA-1387-ESGO Patients with minimal residual disease at upfront debulking surgery have similar survival outcome than patients with complete cytorreduction after neoadjuvant chemotherapy
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  1. Violeta Romero1,
  2. Martina Aida Angeles1,
  3. Elena Rodriguez Gonzalez2,
  4. Anne Sophie Navarro1,
  5. Emmanuela Spagnolo2,
  6. Asunción Pérez-Benavente3,
  7. Bastien Cabarrou4,
  8. Guillaume Bataillon5,
  9. Federico Migliorelli6,
  10. Agnieszka Rychlik7,
  11. Frédéric Guyon8,
  12. Sarah Bétrian1,
  13. Antonio Gil-Moreno3,
  14. Gwénaël Ferron1,
  15. Alicia Hernández2 and
  16. Alejandra Martínez1
  1. 1Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
  2. 2Hospital Universitario La Paz, Madrid, Spain
  3. 3Hospital Vall d’Hebron, Barcelona, Spain
  4. 4Biostatistics Unit, Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
  5. 5Department of Anatomopathology, Institut Universitaire du Cancer de Toulouse – Oncopole, Toulouse, France
  6. 6Paule de Viguier Hospital, Toulouse University Hospital, Toulouse, France
  7. 7Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  8. 8Institut Bergonié, Bordeaux, France

Abstract

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.

Abstract 2022-RA-1387-ESGO Figure 1
Abstract 2022-RA-1387-ESGO Figure 1

Overall survival (A) and disease-free survival (B) curves in patients according surgery modality (PDS or IDS-DDS) and existence of macroscopical residual disease (CC0 or CC1)

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.

https://doi.org/10.1136/ijgc-2022-ESGO.703

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