Prognostic Influence of the Time Interval between Surgery and Chemotherapy in Epithelial Ovarian Cancer

Abstract

The influence of time to chemotherapy (TTC) on recurrence and survival among epithelial ovarian cancer (EOC) patients still remains unknown. This single center retrospective cohort study was conducted on 489 EOC patients who underwent surgery followed by taxane- plus platinum-based chemotherapy in the Shengjing Hospital of China Medical University between 2011 and 2015. The Multivariate cox proportional regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for progression-free survival (PFS) and overall survival (OS) after adjustment for potential confounders. The median follow-up duration was 2.97 years (inter-quartile range from 2.11 to 4.13 years). The recurrence and mortality rate of the all patients was 50.9% (249/489) and 43.6% (213/489), respectively. Having comorbidity, residual disease, ascites, and advanced FIGO stage (III-IV) was associated worse PFS and OS of EOC patients. Compared to TTC less than 14 days, delayed TTC (more than 28 days) was associated with a worse PFS (HR=1.36; 95%CI: 0.96-1.92) and OS (HR=1.38; 95%CI: 0.95-2.00). Notably, in EOC patients with advanced stage, delayed TTC (more than 28 days) was associated with worse PFS (HR=1.51; 95%CI: 1.02-2.24) and OS (HR=1.53; 95%CI: 1.01-2.32) when comparing to TTC less than 14 days. In conclusion, delayed TTC was associated with higher rates of EOC recurrence and survival among these patients with advanced stage. The findings of the present study may provide evidence for gynecologist as well as these ovarian cancer patients to make further decision for the treatment.

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

“…The optimal time to initiate or resume systemic chemotherapy after AEOC is still debated. 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 ].…”

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

“…A single-center, retrospective cohort analysis performed at Shengjing Hospital of China Medical University between 2011 and 2015 included 489 patients with epithelial ovarian cancer who underwent upfront surgery followed by adjuvant therapy with taxane/platinum chemotherapy [ 76 ]. Time to chemotherapy greater than 28 days was associated with worse progression-free survival (HR: 1.36, 95% CI: 0.96–1.92) and OS (HR 1.38, 95% CI: 0.95–2.00).…”

Impact of surgery and chemotherapy timing on outcomes in older versus younger epithelial ovarian cancer patients: A nationwide Danish cohort study

“…It remains unclear at what time point delayed initiation of treatment adversely affects prognosis. Studies have explored the prognostic impact of TTC in EOC; with mixed approaches and results [35][36][37][38]. In a meta-analysis evaluating the effect of TTC on disease recurrence and survival three years after the frontline surgery, TTC was not associated with a higher risk of disease recurrence or death; however, the data were heterogeneous [39].…”