Introduction The purpose of this study was to explore the association between indication for neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) outcomes in patients with advanced epithelial ovarian cancer (EOC) at a high-volume center.

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. Complete gross resection (CGR) was defined as no disease remaining at the completion of IDS.

Results 881 patients were included. Indications for NACT were as follows: 706 (80%) extent of disease only, 16 (1.8%) Aletti criteria, 54 (6.1%) comorbidity, 57 (6.5%) VTE, 49 (5.6%) other patient factors. In total, 623 patients (71%) underwent IDS. Rates of IDS were lowest for patients meeting Aletti criteria (25%), followed by patients with comorbidities (48.1%) then followed by patients with VTE (64.9%). Rates of IDS were similar between patients who underwent NACT due to extent of disease (73.8%) and for other patient factors (75.5%) (p<0.001). Rates of CGR obtained during IDS did not differ by indication for NACT (p=0.56).

Conclusion/Implications Non-modifiable patient-related factors such as Aletti criteria, co-morbidity, and VTE are associated with not undergoing IDS. In patients who undergo IDS, rate of CGR does not differ based on indication for NACT.