Survival outcomes in patients receiving neoadjuvant chemotherapy for advanced ovarian cancer: Does the indication for...

To evaluate the association between indication for neoadjuvant chemotherapy (NACT) and outcomes in advanced epithelial ovarian cancer (EOC).

All patients who presented from January 2015 to December 2022 with newly diagnosed advanced EOC undergoing NACT were included. Patients were grouped by NACT indication: extent of disease only (NACT-EOD), Aletti criteria (NACT-Aletti), venous thromboembolism (NACT-VTE), comorbidity (NACT-comorbidity), or other patient factors (NACT-other). Appropriate statistical analyses were performed.

This study included 874 patients, with median age 68 years (range, 26-97) and median follow-up 17.3 months. Patient cohorts were: 705/874 (80.7 %) NACT-EOD, 18/874 (2.1 %) NACT-Aletti, 52/874 (5.9 %) NACT-comorbidity, 57/874 (6.5 %) NACT-VTE, 42/874 (4.8 %) NACT-other. In total, 620/874 patients (71 %) underwent interval debulking surgery (IDS), and rates were lowest for NACT-Aletti (4/18 [22.2 %]), NACT-comorbidities (25/52 [48.1 %]), and NACT-VTE (37/57 [64.9 %]). Complete gross resection rate did not differ by NACT indication (p = 0.51). Median overall survival (OS) by NACT indication was 38.2 months (95 % CI: 33.6-44.4) for NACT-EOD, 25.9 months (95 % CI: 21.6-33.2) for NACT-comorbidity, 23.7 months (95 % CI: 12.8-34.7) for NACT-VTE, 20.9 months (95 % CI: 6.1-26.5) for NACT-Aletti criteria, and 31.0 months (95 % CI: 21.4-64.2) for NACT-other. A multivariate OS analysis controlling for whether a patient underwent IDS showed no difference in survival between groups (p = 0.13).

Non-modifiable patient factors such as Aletti criteria, co-morbidities, and VTE were associated with not undergoing IDS. Patients in NACT-Aletti criteria or NACT-comorbidity had worse OS than NACT-EOD, likely attributable to a lower rate of IDS.