Does Time-to-Chemotherapy after Primary Complete Macroscopic Cytoreductive Surgery Influence Prognosis for Patients with Epithelial Ovarian Cancer? A Study of the FRANCOGYN Group

Abstract

To determine if the time-to-chemotherapy (TTC) after primary macroscopic complete cytoreductive surgery (CRS) influences recurrence-free survival (RFS) and overall survival (OS) in patients with epithelial ovarian cancer (EOC). We conducted an observational multicenter retrospective cohort analysis of women with EOC treated from September 2006 to November 2016 in nine institutions in France (FRANCOGYN research group) with maintained EOC databases. We included women with EOC (all FIGO stages) who underwent primary complete macroscopic CRS prior to platinum-based adjuvant chemotherapy. Two hundred thirty-three patients were included: 73 (31.3%) in the early-stage group (ESG) (FIGO I-II), and 160 (68.7%) in the advanced-stage group (ASG) (FIGO III-IV). Median TTC was 43 days (36–56). The median OS was 77.2 months (65.9–106.6). OS was lower in the ASG when TTC exceeded 8 weeks (70.5 vs. 59.3 months, p = 0.04). No impact on OS was found when TTC was below or above 6 weeks (78.5 and 66.8 months, respectively, p = 0.25). In the whole population, TTC had no impact on RFS or OS. None of the factors studied were associated with an increase in TTC. Chemotherapy should be initiated as soon as possible after CRS. A TTC greater than 8 weeks is associated with poorer OS in patients with advanced stage EOC.

Factors Predicting 30-Day Grade IIIa–V Clavien–Dindo Classification Complications and Delayed Chemotherapy Initiation after Cytoreductive Surgery for Advanced-Stage Ovarian Cancer: A Prospective Cohort Study

“…Some studies defined delayed chemotherapy as >28 days after surgery [ 9 , 40 ]; our study used a cutoff duration of 42 days based on the Dutch cancer register study [ 12 ]. Despite increased time to adjuvant chemotherapy after surgery having a negative prognostic effect on patient survival, there is no clear international consensus defining a cutoff threshold where risk definitely increases [ 41 ]. Moreover, studies seldom report factors associated with a delay in initiating adjuvant chemotherapy for ovarian cancer.…”

Machine learning algorithms as new screening approach for patients with endometriosis

“…It simply aggregates the findings of each classifier passed into Voting Classifier and predicts the output class based on the highest majority of voting. Voting classifier supports two types of voting: hard voting where the predicted output class is a class with the highest majority of votes; soft voting where the output class is the prediction based on the average of probability given to that class 35 . Chi-Square Test: the Chi-square test is one of the most widely used non-parametric tests, often utilized to test the independence between observed and expected frequencies of one or more attributes in a contingency table.…”

“…It simply aggregates the findings of each classifier passed into Voting Classifier and predicts the output class based on the highest majority of voting. Voting classifier supports two types of voting: hard voting where the predicted output class is a class with the highest majority of votes; soft voting where the output class is the prediction based on the average of probability given to that class 35 .…”

Impact of the Time Interval Between Primary Debulking Surgery and Start of Adjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer

“…Over the past decades, several studies have investigated the best time to initiate chemotherapy after completing surgery to delay disease recurrence in a wide variety of malignancies. 5,[7][8][9][10][11][12] The optimal time to start chemotherapy after surgery in patients with EOC has yet to be well established. Therefore, in this study, we aimed to investigate whether different time intervals between PDS and initiating adjuvant chemotherapy affect the survival of patients with advanced EOC.…”