Introduction/Background The aim of this study was to evaluate the long-term survival benefit of radical surgery for advanced epithelial ovarian, tubal, and primary peritoneal cancers (stages III-IV FIGO 2017) who had primary cytoreductive surgery (PDS), those that received neoadjuvant platinum-based chemotherapy (NAC) followed by interval debulking surgery (IDS) and those that received only chemotherapy (ChT).
Methodology Observational, longitudinal, analytical, and retrospective study of 101 women between January 2008-March 2023. Association between clinical, imaging, serum markers, surgical and pathological characteristics, and disease recurrence and overall survival was examined in univariable and multivariable analysis (Kaplan-Meier and Cox proportional hazard model).
Results With an overall mean follow-up of 42 months. 47 women (PDS), 28 (IDS) and 26 (ChT) women were included.
Rates of complete resection (R0) were 72.3% of patients after PDS and 57.2% of patients after IDS (p=0.217). Postoperative rates of adverse effects and mortality were slightly higher after PDS than after IDS (p=0.793). Median progression-free survival was 60 months in the PDS group and 52 months in the IDS group (p=0.04). Factors in multivariable analysis associated with increased risk of recurrence included residual tumor >1cm (HR: 2.72, 95% CI 1.06–6.98, p= 0.037) and stable/progression in response to chemotherapy (HR 8.85, 95% CI 1.76–44.45, p= 0.008).
Median overall survival was not reached for the PDS group and 78 months for the IDS group (HR: 1.63, 95% CI 0.72–3.65, p= 0.235) and 28 months for the ChT group (HR: 2.47, 95% CI 1.13–5.39, p=0.022).
Conclusion PDS before chemotherapy is the standard of care. Higher complete cytoreduction rate in the PDS group indicates that the correct patients have been selected and those that benefit the most.
Disclosures Complete resection of all macroscopic disease (at primary or interval surgery) was the strongest independent variable in predicting overall survival (HR: 4.52, 95% CI 1.86–11.02, p= 0.001).
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