Article Text
Abstract
Introduction The aim of this study was to evaluate the association between indication for neoadjuvant chemotherapy (NACT) and overall survival (OS) in patients with advanced epithelial ovarian cancer (EOC).
Methods All patients from 12/29/2014 to 1/26/2023 with newly diagnosed advanced EOC undergoing NACT were included. Indications for NACT were categorized as follows: extent of disease only (as determined by imaging or laparoscopy), ‘Aletti criteria’ (age ≥75 years old and extensive disease and serum albumin <3.5 g/dL or American Society of Anesthesiologists score ≥3), venous thromboembolism (VTE), comorbidity, or other. OS was calculated from NACT start date to the date of death or last follow-up. Appropriate statistical analyses were performed.
Results 881 patients were included. Median age was 68 years (range, 26-97). Median follow-up for survivors was 17.5 months. Extent of disease was the most common NACT indication (705 patients, 80%), followed by VTE (57 patients, 6.5%). Median OS by NACT indication was as follows: 38.9 months (95% CI: 35-45.1) for extent of disease, 23.7 months (95% CI: 12.8-34.7) for VTE, 25.9 months (95% CI: 21.6-33.2) for comorbidity, 15.5 months (95% CI: 6.1-23.9) for Aletti criteria, and 30.5 months (95% CI: 21.3-50.5) for other. When considering extent of disease as a baseline, Aletti criteria and comorbidity indications carried OS hazard ratios of 2.93 (95% CI: 1.72-5.01) and 1.7 (95% CI: 1.21-2.38), respectively (p<0.001).
Conclusion/Implications Patients receiving NACT due to Aletti criteria or comorbidity have worse OS than patients triaged to NACT due to disease factors alone.