Introduction/Background A consistent number of advanced ovarian cancer (AOC) patients present with poor performance status. We sought to determine whether neo-adjuvant chemotherapy(NACT) can modify pre-operative characteristics used to identify patients at high risk(HR) of peri-operative complications, as defined by the Mayo Clinic Algorithm
Methodology In this retrospective single center observational study, FIGO stage III-IV AOC patients undergoing NACT from 01/2016 to 12/2019 were collected and triaged as low risk(LR) and HR according to Mayo Clinic Algorithm. HR group included women with at least one of the following criteria:(i) Albumin <3.5 g/dL,(ii) age ≥80 years,(iii) age 75–79 with ECOG performance status >1, stage IV disease, or complex surgery required and (iv) ASA score ≥ 3. Pre-NACT and post-NACT characteristics were compared in the HR group.
Results 177 patients were included, 144(81%) and 33(19%) were classified as HR and LR respectively before NACT. A median number of 4 cycles (range 2–6) of carboplatinum-paclitaxel NACT was administered in HR patients, with bevacizumab addiction in 53% of cases. 115 out of 144 (80%) HR women showed a significant difference in pre-NACT ECOG (p=0.007), ASA score (p=0.001), albumin level(p=0.001) compared to post-NACT setting, taking on LR features. All patients underwent interval surgery and complete cytoreduction was achieved in 97 (84%) cases. Among 42 (35%) post-operative complications, 7(16%) were classified as G3-G4. Median progression free survival was 18 months (CI 95% 14 -21), median overall survival was 54 months (CI 95% 34–73) (figure 1).
Conclusion NACT appeared to improve pre-treatment patient’s characteristics that may account for an increase peri-operative morbidity. A comparison between the analyzed population and a statistically matched group of HR and LR patients undergoing primary debulking surgery is in due course.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.