Primary cytoreductive surgery (PCS) is better than neoadjuvant chemotherapy (NACT) for overall survival in women aged 70 years or younger with advanced-stage epithelial ovarian cancer (EOC), according to a recent study published in JAMA Oncology.
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The study, which was a retrospective analysis of the National Cancer Database led by J Alejandro Rauh-Hain, MD, Division of Gynecologic Oncology, Massachusetts General Hospital (Boston, MA), sought to compare survival between patients with EOC treated with PCS and those treated with NACT. The cohort study sampled 22,962 patients, 19,836 (86.4%) of whom received PCS and 3126 (13.6%) of whom underwent NACT. The cohort was exclusive to women with stage IIIC and IV EOC diagnosed between 2003 and 2011 aged 70 years or younger with a Charlson comorbidity index of 0.
Researchers matched 2935 patients treated with NACT with similar patients who received PCS using propensity score matching. The median follow-up time was 56.5 (95% CI, 54.5-59.2) months in the PCS group and 56.3 (95% CI, 54.5-59.8) months in the NACT group in this cohort. The median overall survival was 37.3 (95% CI, 35.2-38.7) months in the PCS group and 32.1 (95% CI, 30.8-34.1) months in the NACT group (P < .001). Thus, researchers concluded that PCS is associated with improved survival compared with NACT in women with advanced-stage EOC aged 70 years or younger.
Researchers cite the limited proportion of women in the NACT group with performance statuses of 1 or 2, when compared to the PCS group (50% vs 60%, respectively), as potentially contributing to the statistically significant improved survival in the PCS group. Therefore, further studies are needed to validate this study’s findings.
