Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

Abstract

Objective To compare the chemoresistance and survival in patients with stage IIIC or IV epithelial ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS). The clinical characteristics of patients who benefited from NACT were further evaluated. Methods We retrospectively analyzed 220 patients who underwent NACT followed by IDS or PDS from January 2002 to December 2016. Differences in clinicopathological features, chemoresistance and prognosis were analyzed. Results The incidence rate for optimal cytoreduction and chemoresistance in the NACT group was relatively higher than PDS group. No differences were observed in progression free survival or overall survival. Patients without macroscopic RD in NACT group (NACT-R0) had a similar prognosis compared to those in PDS group who had RD<1 cm, and a relatively better prognosis compared to the PDS group that had RD ≥ 1 cm. The survival curve showed that patients in NACT-R0 group that were chemosensitive seemed to have a better prognosis compared to patients in PDS group that had RD. Conclusion Patients without RD after PDS had the best prognosis, whereas patients with RD after NACT followed by IDS had the worst. However, even if patients achieved no RD, their prognosis varied depending on chemosensitivity. Survival was better in patients who were chemosensitive compared to thosewho underwent PDS but had RD. Hence evaluating the chemosensitivity and feasibility of complete cytoreduction in advance is crucial.

Primary Debulking Surgery for Stage III Epithelial Ovarian Cancer Has a Better Outcome Than Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery

“…For patients debulked to RD < 1 cm or to RD ≥ 1 cm after PDS, their prognosis had no significant differences. Moreover, after NACT, patients who were debulked to no RD after IDS had a significantly lower DFS and OS compared to patients with no RD after PDS [26]. These results agree with our results regarding the optimal debulking.…”

Advanced stage ovarian cancer patients with neoadjuvant chemotherapy suffered worse recurrence free survival

“…Rauh-Hain and colleagues found that 88.8% of cases of recurrence in the NACT-IDS group were platinum resistant compared to 55.3% of cases in the PDS group (P = 0.001)27 . The same outcome was also found by Gao, who showed that 40.3% of patients in the NACT-IDS group and 23.1% in the PDS group experienced platinum-resistant recurrence and28 ; similarly, NACT induced chemotherapy resistance in cancer stem cell colonies29 . A limited number of studies have found that the TP53 gene mutation is the most common (70.3%) mutation after courses of NACT compared with before courses of NACT30 ; additionally, in platinum-resistant patients (relapsed within 6 months), the TP53 K351N mutation was significantly more severe in the NACT-IDS group than in the PDS group (57.14% vs 0%, P 0.01).…”

TCP1 Regulates PI3K/AKT/mTOR Signalling Pathway to Promote Ovarian Cancer Cell Proliferation

“…Some statistical data indicated that close to 70% of patients with OC remain undetected until the advanced stage [4]. Currently, the standard treatment for advanced OC is primary cytoreductive surgery followed by combination chemotherapy using platinum and taxane [4][5][6]. Tumour recurrence may ultimately occur in approximately 75% of patients with advanced OC, 20% of which becomes resistant [7].…”