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

Abstract

Aim: To investigate whether the time interval between primary debulking surgery (PDS) and initiating adjuvant chemotherapy affects survival in patients with epithelial ovarian cancer (EOC). Methods: We retrospectively reviewed FIGO stage IIB to IV EOC patients who received PDS followed by adjuvant chemotherapy in our hospital between January 2008 and December 2016. The optimal cut-off time interval to chemotherapy related to survival was determined using the Contal and O'Quigley method and Cox hazard models. Cox regression analysis was used to identify the independent effect of time interval on survival. Results: A total of 152 patients were identified and divided into three groups based on the time interval between PDS and initiating adjuvant chemotherapy: early (<23 days), intermediate (23-43 days) and late (>43 days). The intermediate group had a significantly better median progression-free survival (PFS, 35.5 months) compared to the early (20 months) and late (22.6 months) groups. After adjustments for confounding factors, time interval was still an independent variable affecting PFS. The intermediate group was associated with a better PFS compared with the early and late groups (hazard ratio 0.27, 95% CI 0.10-0.83, p=0.002). There was no statistical significance in overall survival (OS) in univariate or multivariate analysis, although there was a trend towards better OS in the intermediate group. Conclusion:Our results provide evidence that the time interval from PDS to chemotherapy influences PFS in patients with advanced EOC. The optimal time to initiate chemotherapy was between 23 and 43 days, within 3-6 weeks post-operatively. Initiating chemotherapy early (<23 days) did not appear to benefit PFS.

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

“…Generally, it is recommended to start or resume chemotherapy as soon as possible after cytoreductive surgery. Several studies have shown that initiating adjuvant chemotherapy >42 days after cytoreduction is independently associated with adverse survival outcomes [ 10 , 11 , 12 ]. A recent study demonstrated that women with TTC ≤ 42 days had a significantly better median progression-free survival (PFS) compared to those with TTC > 42 days (35.5 vs. 22.6 months) [ 10 ].…”

“…Several studies have shown that initiating adjuvant chemotherapy >42 days after cytoreduction is independently associated with adverse survival outcomes [ 10 , 11 , 12 ]. A recent study demonstrated that women with TTC ≤ 42 days had a significantly better median progression-free survival (PFS) compared to those with TTC > 42 days (35.5 vs. 22.6 months) [ 10 ]. A meta-analysis in patients with International Federation of Gynecology and Obstetrics (FIGO) stage III–IV showed that overall survival (OS) declined by 4% for each week that adjuvant chemotherapy was delayed [ 13 ].…”

Adjuvant Chemotherapy Delay After Primary Debulking Surgery for Advanced Ovarian Cancer at a Teaching Hospital in Southern Nigeria

“…According to research conducted in Nigeria and Africa, ovarian cancer ranks as the second most common gynaecological cancer, comprising approximately 7 to 8.2% of all gynecological malignancies [2]. Unfortunately, around 75% of cases are diagnosed at advanced stages, which can be attributed to the absence of specific clinical manifestations and effective screening methods [3,4]. The survival rate of patients with ovarian cancer is highly dependent on the stage at diagnosis.…”