Selective Advantage of NACT in Advanced Ovarian Cancer: A Retrospective Single-Centre Analysis

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Chemotherapy Research

Background:

• Advanced-stage epithelial ovarian cancer (EOC) carries a poor prognosis.
• Complete macroscopic cytoreduction is the primary modifiable survival predictor in EOC.
• Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative for high tumor burden EOC, but its surgical complexity is debated.

Purpose of the Study:

• To compare operative characteristics and survival outcomes between NACT + IDS and primary debulking surgery (PDS).
• To evaluate surgical complexity using standardized metrics in a real-world setting for advanced EOC.
• To determine the impact of NACT + IDS versus PDS on progression-free survival (PFS) and overall survival (OS).

Main Methods:

• Retrospective analysis of 47 patients with FIGO stage IIIC-IV high-grade serous EOC.
• Comparison between 25 patients receiving NACT + IDS and 22 patients undergoing PDS.
• Quantification of surgical effort via Surgical Complexity Score (SCS) and tumor burden via Peritoneal Cancer Index (PCI); survival analysis using Kaplan-Meier and Cox models.

Main Results:

• Complete cytoreduction (R0) rates were 76% for NACT + IDS and 68% for PDS.
• NACT + IDS group showed significantly lower mean surgical complexity (SCS 5.0 vs. 6.2) and operative time (140 vs. 197 min).
• No significant differences in blood loss, complications, or hospital stay; median PFS was 25 months (NACT + IDS) vs. 21 months (PDS), not statistically significant.

Conclusions:

• NACT + IDS is associated with shorter and less complex surgeries in selected advanced EOC patients.
• Survival outcomes were comparable between NACT + IDS and PDS when complete cytoreduction (R0) was achieved.
• Selective use of NACT + IDS may be suitable for patients with extensive disease or poor health, emphasizing complete cytoreduction as the key prognostic factor.