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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 386-390    DOI: 10.31083/j.ejgo.2020.03.5102
Original Research Previous articles | Next articles
The effect of six scheduled cycles of neoadjuvant chemotherapy on prognosis in advanced ovarian cancer
H. Ishibashi1, M. Miyamoto1(), T. Aoyama1, H. Soyama1, H. Matsuura1, H. Iwahashi1, M. Takano2, K. Furuya1
1Departments of Obstetrics and Gynecology, National Defense Medical College Hospital, Saitama, Tokorozawa, Japan
2Departments of Clinical Oncology, National Defense Medical College Hospital, Saitama, Tokorozawa, Japan
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Abstract  

urpose: This study evaluated the appropriate number of cycles of neoadjuvant chemotherapy (NAC) before interval debulking surgery (IDS) in advanced ovarian cancer. Materials and Methods: Cases with advanced ovarian cancer who received a combination of taxane and platinum as NAC and IDS at this institution between 2001 to 2016 were identified. The cases were divided into two groups; patients who received six or four scheduled cycles of NAC (groups A and B, respectively). Results: Thirty-six cases were in group A and 35 cases in group B. Progression-free survival (PFS) and overall survival (OS) in group A were better than those in group B (p = 0.01, < 0.01). In multivariate analysis, six scheduled cycles of NAC was an independent better prognostic factor for PFS (hazard ratio (HR), 0.56, p = 0.04) and OS (HR, 0.39; p = 0.01). Conclusion: In advanced ovarian cancer, six scheduled cycles of NAC demonstrated a better prognosis.

Key words:  Ovarian carcinoma      Neoadjuvant chemotherapy      Primary debulking surgery      Interval debulking surgery     
Submitted:  14 December 2018      Accepted:  14 February 2019      Published:  15 June 2020     
*Corresponding Author(s):  M. Miyamoto     E-mail:  morikazu1118@hotmail.co.jp

Cite this article: 

H. Ishibashi, M. Miyamoto, T. Aoyama, H. Soyama, H. Matsuura, H. Iwahashi, M. Takano, K. Furuya. The effect of six scheduled cycles of neoadjuvant chemotherapy on prognosis in advanced ovarian cancer. European Journal of Gynaecological Oncology, 2020, 41(3): 386-390.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5102     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/386

Table 1  — Clinicopathological factors of all cases of advanced ovarian cancer.
Cases with six scheduled cycles of neoadjuvant chemotherapy Cases with four scheduled cycles of neoadjuvant chemotherapy
Clinicopathological factors n = 36 n = 35 p-value
Neoadjuvant chemotherapy cycles, median(range) 6 (5-6) 4 (1-4) < 0.01
Age at diagnosis (years), mean ± SD (range) 59.0 ± 10.8 (31-78) 61.5 ± 8.2 (44-75) 0.39
CA125 level at diagnosis, mean ± SD (range)
(UI/ml)
421 ± 3152 (11-18820) 591 ± 2275 (31-15310) 0.19
FIGO Stage, number (%) 0.8
III 23 (63.9) 24 (68.6)
IV 13 (36.1) 11 (31.4)
Histological subtype, number (%) 0.26
High-grade serous carcinoma 33 (91.7) 29 (82.8)
Non-high-grade serous carcinoma 3 (8.3) 6 (17.2)
Response to NAC at IDS, number (%) 0.99
Complete response 7 (19.4) 7 (20.0)
Partial response 29 (80.6) 28 (80.0)
Residual tumor diameters at IDS, number (%) 0.04
Optimal surgery 32 (88.9) 24 (68.6)
Suboptimal surgery 4 (11.1) 11 (31.4)
Operative time at IDS, mean ± SD (minutes) (range) 241.0 ± 85.1 (68-420) 207 ± 92.7 (84-566) 0.02
Blood loss at IDS, mean ± SD (ml) (range) Allogenic blood transfusion at IDS (%) 943 ± 704 (30-2572) 562 ± 308 (107-1420) 0.04
< 0.01
Done 21 (58.3) 9 (25.7)
Not done 15 (41.7) 26 (74.3)
Adjuvant chemotherapy regimen, number (%) 0.71
Taxane-platinum based chemotherapy* 31 (86.1) 32 (91.4)
Other** 5 (13.9) 3 (8.6)
Table 2  — Adverse events during neoadjuvant chemotherapy in all cases of advanced ovarian cancer.
Cases with six scheduled cycles of neoadjuvant chemotherapy Cases with four scheduled cycles of neoadjuvant chemotherapy
n = 36 n = 35 p-value
Grade 2-4 toxicity at NAC, number (%) 9 (25.0) 9 (25.7) 0.99
Thrombocytopenia 4 (11.1) 1 (2.9) 0.36
Anemia 0 (0.0) 1 (2.9) 0.49
Leukopenia 1 (2.8) 3 (8.6) 0.36
Drug allergy 3 (8.3) 0 (0.0) 0.24
Neuropathy 1 (2.8) 3 (8.6) 0.36
Hepatobiliary disorders 0 (0.0) 1 (2.9) 0.49
Not evaluable/missing data 2 (5.6) 3 (8.6) 0.67
Figure 1.  — Progression-free survival (PFS) curves and overall survival (OS) curves of all cases that received neoadjuvant chemotherapy (NAC). A) PFS curves of cases administered six (group A) or four (group B) scheduled cycles of NAC. There was a significant difference in PFS (p = 0.01) between the two groups. Red line, group A; blue line, group B. B) OS curves of cases administered six (group A) or four (group B) scheduled cycles of NAC. There was a significant difference in OS (p < 0.01) between two groups. Red line, group A; blue line, group B.

Table 3  — Multivariate analysis of progression-free and overall survival in all cases receiving neoadjuvant chemotherapy.
Progression-free survival Overall survival
3-6 Clinicopathological factors This section was collected Hazard ratio (95% CI) p-value Hazard ratio (95% CI) p-value
Age at diagnosis 60 years vs. < 60 years 1.07 (0.63-1.87) 0.8 0.85 (0.42-1.75) 0.66
NAC cycles Six scheduled cycles vs. four 0.56 (0.32-0.96) 0.04 0.39 (0.18-0.82) 0.01
scheduled cycles
FIGO stage III vs. IV 1.14 (0.66-2.01) 0.65 1.31 (0.63-2.93) 0.48
Residual tumor diameters at Optimal vs. suboptimal 0.65 (0.66-2.01) 0.18 1.06 (0.48-2.60) 0.9
IDS
Histology High grade serous carcinoma 0.66 (0.33-1.52) 0.3 0.89 (0.34-3.06) 0.83
vs. non-high-grade serous car-
cinoma
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