Primary or interval debulking surgery for stage IV ovarian cancer patients: experience from a ten-year case series

Background Whether patients with stage IV ovarian cancer can benefit from neoadjuvant chemotherapy (NACT) is unclear. The main aim was to compare the survival outcomes of primary debulking surgery (PDS) versus NACT followed by interval debulking surgery (IDS) in stage IV ovarian cancer patients. Methods This study retrospectively analyzed 190 consecutive patients with stage IV ovarian cancer who underwent either PDS or NACT + IDS between June 2003 and June 2013 at Fudan University Shanghai Cancer Center. Progression free survival (PFS) and overall survival (OS) were analyzed with Kaplan-Meier method. Multivariable cox proportional hazard models tested for associations of potential explanatory variables with survival. Results A total of 111 patients underwent PDS and 79 patients received NACT + IDS. More NACT patients had stage IVB disease compared with PDS patients (p = 0.001). Additionally, a higher rate of complete resection (45.6% vs 21.6%, p < 0.001) was achieved in NACT patients compared to those with PDS. There was no significant difference of platinum sensitivity between the two groups (p = 0.998). The median PFS for PDS and NACT groups were 14 (95%CI, 12–16) and 16 (95%CI, 13–17) months, respectively (p = 0.744). The median OS were 40 (95%CI, 31–49) and 53(95% CI, 41–65) months for PDS and NACT groups, respectively (p = 0.094). In addition, NACT was more beneficial than PDS in patients with extra-abdominal lymph node metastases (median OS (95%CI) = 37 (24–50) vs 60 (41–79) months, p = 0.006). Conclusions There were no significant survival differences between PDS and NACT groups for stage IV ovarian cancer patients. However, NACT had survival benefit in patients with extra-abdominal lymph node metastases.