Does the primary treatment sequence affect post-relapse survival in recurrent epithelial ovarian cancer? A real-world multicentre retrospective study

ObjectiveTo explore the impact of the primary treatment sequence (primary debulking surgery, PDS, versus neoadjuvant chemotherapy and interval debulking surgery, NACT-IDS) on post-relapse survival (PRS) and recurrence characteristics of recurrent epithelial ovarian cancer (REOC). DesignReal-world retrospective study. SettingTertiary hospitals in China. PopulationA total of 853 patients with REOC at International Federation of Gynaecology and Obstetrics stages IIIC-IV from September 2007 to June 2020. Overall, 377 and 476 patients received NACT-IDS and PDS, respectively. MethodsPropensity score-based inverse probability of treatment weighting (IPTW) was performed to balance the between-group differences. Main Outcome MeasuresClinicopathological factors related to PRS. ResultsThe overall median PRS was 29.3 months (95% CI 27.0-31.5 months). Multivariate analysis before and after IPTW adjustment showed that NACT-IDS and residual R1/R2 disease were independent risk factors for PRS (p < 0.05). Patients with diffuse carcinomatosis and platinum-free interval (PFI) <= 12 months had a significantly worse PRS (p < 0.001). Logistic regression analysis revealed that NACT-IDS was an independent risk factor for diffuse carcinomatosis (OR 1.36, 95% CI 1.01-1.82, p = 0.040) and PFI <= 12 months (OR 1.59, 95% CI 1.08-2.35, p = 0.019). In IPTW analysis, NACT-IDS was still significantly associated with diffuse carcinomatosis (OR 1.29, 95% CI 1.05-1.58, p = 0.015) and PFI <= 12 months (OR 1.90, 95% CI 1.52-2.38, p < 0.001). ConclusionsThe primary treatment sequence may affect the PRS of patients with REOC by altering the recurrence pattern and PFI duration.

Automated summary

This study explored the impact of the primary treatment sequence on the post-relapse survival and recurrence characteristics of recurrent epithelial ovarian cancer. The results showed that neoadjuvant chemotherapy and interval debulking surgery were associated with post-relapse survival and may lead to worse recurrence pattern and shorter platinum-free interval.