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Outcomes of minimal residual disease at upfront debulking surgery compared with complete cytoreduction after neoadjuvant chemotherapy
  1. Violeta Romero1,
  2. Martina Aida Angeles2,
  3. Elena Rodríguez González1,
  4. Bastien Cabarrou3,
  5. Antonio Gil-Moreno2,
  6. Asunción Pérez-Benavente2,
  7. Emanuela Spagnolo1,
  8. Frédéric Guyon4,
  9. Guillaume Babin4,
  10. Vicente Bebia2,
  11. Ana Luzarraga Aznar2,
  12. Guillaume Bataillon4,
  13. Sarah Bétrian5,
  14. Gwénaël Ferron6,7,
  15. Alicia Hernández1 and
  16. Alejandra Martinez6,8
    1. 1Gynecological Oncology Unit, La Paz Investigation Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain
    2. 2Gynecological Oncology Unit, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
    3. 3Biostatistics Unit, Institut Claudius Regaud, Toulouse University Cancer Institute (IUCT) – Oncopole, Toulouse, France
    4. 4Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
    5. 5Department of Medical Oncology, Institut Claudius Regaud, Toulouse University Cancer Institute (IUCT) – Oncopole, Toulouse, France
    6. 6Department of Surgical Oncology, Institut Claudius Regaud, Toulouse University Cancer Institute (IUCT) – Oncopole, Toulouse, France
    7. 7Oncogenesis of Sarcomas (ONCOSARC) team 19, Cancer Research Center of Toulouse (CRCT), INSERM, Toulouse, France
    8. 8Tumor Immunology and Immunotherapy team 1, Cancer Research Center of Toulouse (CRCT), INSERM, Toulouse, France
    1. Correspondence to Dr Martina Aida Angeles, Department of Gynecological Oncology, Universitat Autònoma de Barcelona, Barcelona, Spain; martinangeles22{at}hotmail.com

    Abstract

    Objective The aim of this study was to compare surgical complexity, post-operative complications, and survival outcomes between patients with minimal residual disease (completeness of cytoreduction (CC) score) CC-1 at the time of primary debulking surgery and those with complete cytoreduction (CC-0) at the time of interval debulking surgery.

    Methods A retrospective multicenter study was conducted of patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage IIIC–IV) who underwent cytoreductive surgery achieving either minimal or no residual disease between January 2008 and December 2015. Patients underwent either primary or interval debulking surgery after receiving ≥3 cycles of neoadjuvant chemotherapy. The sub-group of patients with primary debulking surgery/CC-1 was compared with those with interval debulking surgery/CC-0. Overall survival and disease-free survival were estimated using the Kaplan–Meier method.

    Results A total of 549 patients were included, with upfront surgery performed in 175 patients (31.9%) and 374 patients (68.1%) undergoing interval debulking surgery. After primary debulking surgery, 157/175 (89.7%) had complete cytoreduction and 18/175 (10.3%) had minimal residual disease (primary debulking surgery/CC-1 group), while after interval debulking surgery, 324/374 (86.6%) had complete cytoreduction (interval debulking surgery/CC-0 group) and 50/374 (13.4%) had minimal residual disease. The rate of patients with peritoneal cancer index >10 was 14/17 (82.4%) for the primary debulking surgery/CC-1 group and 129/322 (40.1%) for the interval debulking surgery/CC-0 (p<0.001). The rate of patients with an Aletti score of ≥8 was 11/18 (61.1%) and 132/324 (40.7%), respectively (p=0.09) and the rate of major post-operative complications was 5/18 (27.8%) and 64/324 (19.8%), respectively (p=0.38). Overall median disease-free and overall survival were 19.4 months (95% CI 18.0 to 20.6) and 56.7 months (95%CI 50.2 to 65.8), respectively. Median disease-free survival for the primary debulking surgery/CC-1 group was 16.7 months (95% CI 13.6 to 20.0) versus 18.2 months (95% CI 16.4 to 20.0) for the interval debulking surgery/CC-0 group (p=0.56). Median overall survival for the primary debulking surgery/CC-1 group was 44.7 months (95% CI 34.3 to not reached) and 49.4 months (95% CI 46.2 to 57.3) for the interval debulking surgery/CC-0 group (p=0.97).

    Conclusions Patients with primary debulking surgery with minimal residual disease and those with interval debulking surgery with no residual disease had similar survival outcomes. Interval surgery should be considered when achieving absence of residual disease is challenging at upfront surgery, given the lower tumor burden found during surgery.

    • Postoperative complications
    • Carcinoma, Ovarian Epithelial
    • Gynecologic Surgical Procedures
    • Ovarian Cancer
    • Peritoneal Neoplasms

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/ijgc-2024-005692

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • VR and MAA are joint first authors.

      • AH and AM are joint senior authors.

      • X @AngelesFite, @lebeche, @Alejandra

      • VR and MAA contributed equally.

      • AH and AM contributed equally.

      • Contributors VR: Conceptualization, data curation, methodology, writing – original draft. MAA: Conceptualization, data curation, methodology, writing – original draft. ERG: Conceptualization, data curation, methodology, writing – original draft. BC: Conceptualization, data curation, methodology, statistical analyses, writing – review. AG-M: Conceptualization, project administration, methodology, writing – review. AP-B: Conceptualization, project administration, methodology, writing – review. ES: Conceptualization, data curation, methodology, writing – review. FG: Conceptualization, project administration, methodology, writing – review. GBab: Conceptualization, data curation, methodology, writing – review. VB: Conceptualization, project administration, methodology, writing – review. ALA: Conceptualization, project administration, methodology, writing – review. GBat: Conceptualization, project administration, methodology, writing – review. SB: Conceptualization, project administration, methodology, writing – review. GF: Conceptualization, project administration, methodology, writing – review. AH: Conceptualization, project administration, methodology, writing – review. AM: Conceptualization, project administration, methodology, writing – review. MAA is the guarantor.

      • 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.