Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?: A nationwide Danish study

Carsten Lindberg Fagö-Olsen; Bent Ottesen; Henrik Kehlet; Sofie L Antonsen; Ib J Christensen; Algirdas Markauskas; Berit J Mosgaard; Christian Ottosen; Charlotte H Soegaard; Erik Soegaard-Andersen; Claus Hoegdall

doi:10.1016/j.ygyno.2013.11.035

Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study

Carsten Lindberg Fagö-Olsen, Bent Ottesen, Henrik Kehlet, Sofie L Antonsen, Ib J Christensen, Algirdas Markauskas, Berit J Mosgaard, Christian Ottosen, Charlotte H Soegaard, Erik Soegaard-Andersen, Claus Hoegdall

43 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Gynecologic Oncology
Volume	132
Issue number	2
Pages (from-to)	292-298
Number of pages	7
ISSN	0090-8258
DOIs	https://doi.org/10.1016/j.ygyno.2013.11.035
Publication status	Published - Feb 2014

Keywords

Aged
Chemotherapy, Adjuvant
Cohort Studies
Denmark
Female
Humans
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms
Retrospective Studies
Survivors
Treatment Outcome

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.ygyno.2013.11.035

Cite this

Fagö-Olsen, C. L., Ottesen, B., Kehlet, H., Antonsen, S. L., Christensen, I. J., Markauskas, A., Mosgaard, B. J., Ottosen, C., Soegaard, C. H., Soegaard-Andersen, E., & Hoegdall, C. (2014). Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. Gynecologic Oncology, 132(2), 292-298. https://doi.org/10.1016/j.ygyno.2013.11.035

Fagö-Olsen, CL, Ottesen, B, Kehlet, H, Antonsen, SL, Christensen, IJ, Markauskas, A, Mosgaard, BJ, Ottosen, C, Soegaard, CH, Soegaard-Andersen, E & Hoegdall, C 2014, 'Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study', Gynecologic Oncology, vol. 132, no. 2, pp. 292-298. https://doi.org/10.1016/j.ygyno.2013.11.035

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abstract = "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.",

keywords = "Aged, Chemotherapy, Adjuvant, Cohort Studies, Denmark, Female, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Retrospective Studies, Survivors, Treatment Outcome",

author = "Fag{\"o}-Olsen, {Carsten Lindberg} and Bent Ottesen and Henrik Kehlet and Antonsen, {Sofie L} and Christensen, {Ib J} and Algirdas Markauskas and Mosgaard, {Berit J} and Christian Ottosen and Soegaard, {Charlotte H} and Erik Soegaard-Andersen and Claus Hoegdall",

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doi = "10.1016/j.ygyno.2013.11.035",

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journal = "Gynecologic Oncology",

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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

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 -