TY - JOUR
T1 - Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?
T2 - A nationwide Danish study
AU - Fagö-Olsen, Carsten Lindberg
AU - Ottesen, Bent
AU - Kehlet, Henrik
AU - Antonsen, Sofie L
AU - Christensen, Ib J
AU - Markauskas, Algirdas
AU - Mosgaard, Berit J
AU - Ottosen, Christian
AU - Soegaard, Charlotte H
AU - Soegaard-Andersen, Erik
AU - Hoegdall, Claus
N1 - Copyright © 2013 Elsevier Inc. All rights reserved.
PY - 2014/2
Y1 - 2014/2
N2 - Objective In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS). Methods All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records. Results Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT-IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT-IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39-2.35). Conclusions No difference in MOS was observed between PDS and NACT-IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT-IDS could be associated with increased risk of death after two years of follow-up.
AB - Objective In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS). Methods All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records. Results Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT-IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT-IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39-2.35). Conclusions No difference in MOS was observed between PDS and NACT-IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT-IDS could be associated with increased risk of death after two years of follow-up.
KW - Aged
KW - Chemotherapy, Adjuvant
KW - Cohort Studies
KW - Denmark
KW - Female
KW - Humans
KW - Middle Aged
KW - Neoadjuvant Therapy
KW - Neoplasm Staging
KW - Neoplasms, Glandular and Epithelial
KW - Ovarian Neoplasms
KW - Retrospective Studies
KW - Survivors
KW - Treatment Outcome
U2 - 10.1016/j.ygyno.2013.11.035
DO - 10.1016/j.ygyno.2013.11.035
M3 - Journal article
C2 - 24321400
SN - 0090-8258
VL - 132
SP - 292
EP - 298
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 2
ER -
