A new study suggests incorporating cytoreductive surgery into the initial management of epithelial ovarian cancer (EOC) significantly improves survival compared to chemotherapy alone.
The retrospective study, published in the Annals of Surgical Oncology, compared outcomes from patients treated for advanced EOC at two UK centres (A and B) between January 2013 and December 2014.
Among 249 patients, there were no significant differences in International Federation of Gynecology and Obstetrics (FIGO) stage (FIGO 4, 29.7% at both centres), Eastern Cooperative Oncology Group (ECOG) performance status (ECOG
Receipt of chemotherapy and palliative treatment alone were equivalent between the two centres (3.6%). However, patients at centre A were more likely to undergo surgery (87% vs 59.8%; P
Mayo Clinic surgical complexity score (SCS) was significantly higher at centre A (9 vs 2; P
Independent predictors of reduced overall survival (OS) were non-serous histology (hazard ratio [HR] 1.6; 95% CI 1.04-2.61), ECOG >2 (HR 1.9; 95% CI 1.15-3.13), and palliation alone (HR 3.43; 95% CI 1.51-7.81).
Cytoreduction, at any time, had an independent protective impact on OS compared with chemotherapy alone (HR 0.31 for interval surgery and 0.39 for primary surgery), even after adjustment for other prognostic factors.
The authors concluded that incorporating surgery into initial EOC management, even for patients with greater tumour burden and more disseminated disease, may require more complex procedures and more resources in terms of theatre time and hospital stay, but seems to be associated with a significant prolongation of OS compared with chemotherapy alone.