Real-world outcomes of neoadjuvant chemotherapy for advanced ovarian cancer: What happens to patients who never undergo surgery?
To describe the outcomes of patients with advanced ovarian cancer (OC) treated with neoadjuvant chemotherapy who do and do not undergo interval cytoreductive surgery (ICS). This was a retrospective cohort study of patients with stage III/IV epithelial OC who began treatment with at least three cycles of chemotherapy from 2017 to 2022. Primary analysis compared 3-year progression-free (PFS) and overall (OS) survival for patients who underwent ICS to those who received chemotherapy only (planned ICS not performed). Secondary analyses stratified by timing of ICS and optimal surgical candidacy. We report OS based on Kaplan-Meier curves and Cox proportional hazards models, univariate and multivariate (MVA), controlling for clinically and statistically significant covariates. Of 176 patients, 138 (78.4 %) underwent ICS and 38 (21.6 %) underwent chemotherapy only. Chemotherapy-only patients were older and more comorbid with worse performance status and lower albumin. Groups were similar in pre-treatment stage, histology, and CA-125 normalization. Chemotherapy-only patients had shorter 3-year PFS and OS compared to ICS (3-year PFS 7.2 % vs 22.0 %; OS 14.0 % vs 61.1 %). In MVA, receiving chemotherapy only was independently associated with recurrence (adjusted hazard ratio (aHR) 2.58; 95 % confidence interval (CI) 1.63-4.10) and death (aHR 4.60; 95 % CI 2.43-8.71). A notable proportion of patients with advanced OC who begin treatment with chemotherapy will never undergo cytoreductive surgery. Interval surgery appears beneficial in most instances, and thus, should continue to be recommended for patients who demonstrate response to chemotherapy, are fit surgical candidates, and have a reasonable likelihood of a successful operation.