Survival after interval and delayed cytoreduction surgery in advanced ovarian cancer: a Global Gynaecological Oncology Surgical Outcomes Collaborative-Led Study (GO SOAR2).

IF 4.1 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Faiza Gaba, Oleg Blyuss, Karen Ash
{"title":"Survival after interval and delayed cytoreduction surgery in advanced ovarian cancer: a Global Gynaecological Oncology Surgical Outcomes Collaborative-Led Study (GO SOAR2).","authors":"Faiza Gaba, Oleg Blyuss, Karen Ash","doi":"10.1016/j.ijgc.2025.101650","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Although trials of neoadjuvant chemotherapy for ovarian cancer use 3 cycles, real world practice varies. We evaluated the effect of higher order cycles of chemotherapy, followed by cytoreduction surgery or no surgery on survival, tumor resectability, and post-operative morbidity.</p><p><strong>Methods: </strong>For our international, retrospective cohort study, the inclusion criteria were women with stage III to IV ovarian cancer undergoing interval (after 3-4 cycles of chemotherapy) or delayed (≥5 cycles) cytoreduction surgery or no cytoreduction surgery with chemotherapy alone (≥5 cycles). Multivariate regression analyses were used to model the effect of impact variables on overall survival and tumor resectability.</p><p><strong>Results: </strong>Data were collected from 2498 patients from 22 centers across 12 countries. In total, 60.2% (n = 1504) underwent interval cytoreduction surgery, 30.4% (n = 760) underwent delayed cytoreduction surgery, and 9.4% (n = 234) did not undergo surgery. In the interval, delayed, and no-surgery groups, the mean follow-up periods were 57, 69, and 39 months, respectively. Patients undergoing interval versus delayed cytoreduction were more likely to achieve no residual tumor mass (no macroscopic residual disease [R0] = 72.2%, 1072/1484; 64.6%, 490/758). Patients who underwent interval versus delayed cytoreduction surgery had a greater proportion of minor (Clavien-Dindo 1-2, 32%, 471/1473; 28%, 212/756) and major (Clavien-Dindo 3-5, 9.6%, 141/1473; 8.6%, 65/756) morbidities. Interval cytoreduction surgery was associated with statistically significant greater overall survival than delayed cytoreduction surgery (HR 0.81, p = .01). R0 at the time of delayed cytoreduction was not equivalent to R0 at the time of cytoreductive surgery. R0 in the interval setting was associated with better overall survival (HR 0.77, p = .01). Patients who did not undergo surgery had twice as poor overall survival compared with patients who underwent delayed cytoreduction surgery (HR 2.01, p < .001).</p><p><strong>Conclusions: </strong>Women receiving >4 neoadjuvant chemotherapy cycles had poorer overall survival, despite achieving R0 at surgery. Early maximum effort cytoreduction surgery with R0 in high volume centers and appropriate surgical resources are critical for increasing overall survival.</p>","PeriodicalId":14097,"journal":{"name":"International Journal of Gynecological Cancer","volume":" ","pages":"101650"},"PeriodicalIF":4.1000,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Gynecological Cancer","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijgc.2025.101650","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Although trials of neoadjuvant chemotherapy for ovarian cancer use 3 cycles, real world practice varies. We evaluated the effect of higher order cycles of chemotherapy, followed by cytoreduction surgery or no surgery on survival, tumor resectability, and post-operative morbidity.

Methods: For our international, retrospective cohort study, the inclusion criteria were women with stage III to IV ovarian cancer undergoing interval (after 3-4 cycles of chemotherapy) or delayed (≥5 cycles) cytoreduction surgery or no cytoreduction surgery with chemotherapy alone (≥5 cycles). Multivariate regression analyses were used to model the effect of impact variables on overall survival and tumor resectability.

Results: Data were collected from 2498 patients from 22 centers across 12 countries. In total, 60.2% (n = 1504) underwent interval cytoreduction surgery, 30.4% (n = 760) underwent delayed cytoreduction surgery, and 9.4% (n = 234) did not undergo surgery. In the interval, delayed, and no-surgery groups, the mean follow-up periods were 57, 69, and 39 months, respectively. Patients undergoing interval versus delayed cytoreduction were more likely to achieve no residual tumor mass (no macroscopic residual disease [R0] = 72.2%, 1072/1484; 64.6%, 490/758). Patients who underwent interval versus delayed cytoreduction surgery had a greater proportion of minor (Clavien-Dindo 1-2, 32%, 471/1473; 28%, 212/756) and major (Clavien-Dindo 3-5, 9.6%, 141/1473; 8.6%, 65/756) morbidities. Interval cytoreduction surgery was associated with statistically significant greater overall survival than delayed cytoreduction surgery (HR 0.81, p = .01). R0 at the time of delayed cytoreduction was not equivalent to R0 at the time of cytoreductive surgery. R0 in the interval setting was associated with better overall survival (HR 0.77, p = .01). Patients who did not undergo surgery had twice as poor overall survival compared with patients who underwent delayed cytoreduction surgery (HR 2.01, p < .001).

Conclusions: Women receiving >4 neoadjuvant chemotherapy cycles had poorer overall survival, despite achieving R0 at surgery. Early maximum effort cytoreduction surgery with R0 in high volume centers and appropriate surgical resources are critical for increasing overall survival.

晚期卵巢癌间隔期和延迟细胞减少手术后的生存:一项全球妇科肿瘤手术结果合作主导的研究(GO SOAR2)。
目的:虽然卵巢癌新辅助化疗的试验使用3个周期,但现实世界的实践各不相同。我们评估了高阶化疗周期,随后进行细胞减少手术或不进行手术对生存率、肿瘤可切除性和术后发病率的影响。方法:在我们的国际回顾性队列研究中,纳入标准是接受间隔(化疗3-4个周期后)或延迟(≥5个周期)细胞减少手术或单独化疗(≥5个周期)不进行细胞减少手术的III至IV期卵巢癌妇女。多变量回归分析用于模拟影响变量对总生存率和肿瘤可切除性的影响。结果:数据来自12个国家22个中心的2498名患者。总的来说,60.2% (n = 1504)接受了间隔细胞减少手术,30.4% (n = 760)接受了延迟细胞减少手术,9.4% (n = 234)没有接受手术。在间隔、延迟和非手术组中,平均随访时间分别为57个月、69个月和39个月。间隔性细胞减少与延迟性细胞减少的患者更有可能实现无肿瘤残留(无宏观残留病变[R0] = 72.2%, 1072/1484;64.6%, 490/758)。接受间隔和延迟细胞减少手术的患者有更大比例的轻微(Clavien-Dindo 1-2, 32%, 471/1473;28%, 212/756)和major (Clavien-Dindo 3-5, 9.6%, 141/1473;8.6%(65/756)的发病率。间隔细胞减少手术与延迟细胞减少手术的总生存率有统计学意义(HR 0.81, p = 0.01)。延迟细胞减少时的R0与细胞减少手术时的R0不相等。间期R0与更好的总生存率相关(HR 0.77, p = 0.01)。与接受延迟细胞减少手术的患者相比,未接受手术的患者的总生存率是后者的两倍(HR 2.01, p < .001)。结论:接受bbbb4新辅助化疗周期的女性总体生存期较差,尽管在手术中达到了R0。在大容量中心进行早期最大努力的R0细胞减少手术和适当的手术资源是提高总生存率的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信