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Original research
Impact of adjuvant chemotherapy on the overall survival of patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery
  1. Dimitrios Nasioudis1,
  2. Xiaolei Wang1,
  3. Gurdial Dhillon2,
  4. Nawar Latif1,
  5. Emily M Ko1,
  6. Robert L Giuntoli II1,
  7. David Gershenson3,
  8. Amanda Fader4,
  9. Mark Carey2 and
  10. Fiona Simpkins1
  1. 1 Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2 Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4 The Johns Hopkins Hospital, Baltimore, Maryland, USA
  1. Correspondence to Dr Dimitrios Nasioudis, Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; dimitrios.nasioudis{at}pennmedicine.upenn.edu

Abstract

Objective To investigate the use and outcomes of adjuvant chemotherapy for patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery.

Methods Patients diagnosed between 2010 and 2015 with International Federation of Gynecology and Obstetrics stage II–IV low-grade serous ovarian carcinoma who underwent primary debulking surgery with known residual disease status and had at least 1 month of follow-up were identified in the National Cancer Database. Adjuvant chemotherapy was defined as receipt of chemotherapy within 6 months of surgery. Overall survival was evaluated using the Kaplan-Meier method and compared with the log-rank test. A Cox model was constructed to control for a priori-selected confounders. A systematic review of the literature was also performed.

Results In total, 618 patients with stage II–IV low-grade serous ovarian carcinoma who underwent primary cytoreductive surgery were identified; 501 (81.1%) patients received adjuvant chemotherapy, while 117 (18.9%) patients did not. The median follow-up of the present cohort was 47.97 months. There was no difference in overall survival between patients who did and did not receive adjuvant chemotherapy (p=0.78; 4-year overall survival rates were 77.5% and 76.1%, respectively). After controlling for patient age, medical co-morbidities, disease stage, and residual disease status, administration of adjuvant chemotherapy was not associated with better overall survival (HR=0.87, 95% CI 0.55 to 1.38). Based on data from three retrospective studies, omission of adjuvant chemotherapy following cytoreductive surgery was not associated with worse progression-free survival benefit (HR=1.25, 95% CI 0.80 to 1.95) for patients with stage III–V low-grade serous ovarian carcinoma.

Conclusions Adjuvant chemotherapy may not be associated with an overall survival benefit for patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery.

  • Ovarian Cancer
  • Carcinoma, Ovarian Epithelial

Data availability statement

Data may be obtained from a third party and are not publicly available. Data obtained from American College of Surgeons and Commission on Cancer.

https://doi.org/10.1136/ijgc-2023-004745

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from American College of Surgeons and Commission on Cancer.

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    Footnotes

    • Twitter @amandanfader

    • Contributors DN conception, data acquisition, data management, statistical analysis, critical analysis, drafting/final editing, guarantor. XW, GD, NL, EMK, RLG, DG, AF, MC critical analysis, drafting/final editing. FS supervision, critical analysis, drafting/final editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.