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Neoadjuvant Chemotherapy, Case Volume, and Mortality in Advanced Ovarian Cancer.
Mary Kathryn Abel1, Varvara Mazina1, Amy J Bregar1
1Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Boston.
JAMA Network Open
|July 25, 2025
Summary
Neoadjuvant chemotherapy (NACT) use in advanced ovarian cancer surgery significantly lowers 90-day mortality, especially in high-volume hospitals. Higher NACT rates improve survival, particularly benefiting patients treated at high-volume centers.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Health Services Research
Background:
- Cytoreductive surgery for advanced ovarian cancer has higher mortality in low-volume hospitals.
- Neoadjuvant chemotherapy (NACT) can reduce surgical complexity and mortality.
- The association between NACT utilization and surgical outcomes by hospital volume is not well-defined.
Purpose of the Study:
- To determine if increased NACT use correlates with reduced postoperative mortality and improved survival after cytoreductive surgery.
- To investigate this association specifically within low-volume hospitals.
Main Methods:
- Cross-sectional study of 70,707 patients with stage III/IV ovarian cancer from 2010-2019.
- Analysis of cancer program-level NACT rates and hospital annual surgical volume tertiles.
- Outcomes measured: 90-day perioperative mortality and 60-month life expectancy.
Main Results:
- Higher NACT rates were associated with lower 90-day surgical mortality, with a significant interaction by hospital volume (P < .001).
- High NACT utilization (59%) showed a greater mortality reduction in high-volume centers (OR, 0.26) compared to low-volume centers (OR, 0.48).
- High NACT use in high-volume centers improved 60-month life expectancy by 4.0 months.
Conclusions:
- Treatment at high-volume centers with high NACT utilization is linked to the lowest 90-day surgical mortality.
- High NACT utilization in high-volume settings is associated with improved long-term survival for advanced ovarian cancer patients.
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