Association between time to adjuvant chemotherapy and survival in ovarian cancer patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy

Abstract

Introduction

Delayed adjuvant chemotherapy (AC) worsens survival in advanced ovarian cancer (OC), but data on its impact after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is limited. We aimed to assess if delayed AC negatively affects survival in OC patients treated with CRS/HIPEC.

Methods

We conducted a retrospective analysis of a single-center prospective database including FIGO stage III-IV epithelial OC patients who underwent initial CRS/HIPEC (upfront or interval) followed by AC. Patients were grouped into delayed AC (≥60 days) and no delay (<60 days). Patient characteristics were compared. Logistic regression identified risk factors for delay. Kaplan-Meier method and stratified Wilcoxon test were used for survival analysis.

Results

Of 95 patients identified, 43 (45.3 %) were delayed, while 52 (54.7 %) had no delay. Delayed patients were significantly older (p = 0.013), had higher stage (p = 0.038) and peritoneal cancer index (PCI) (p = 0.020), more Clavien-Dindo grade III-IV complications (p = 0.002), and longer hospital stay (p = 0.003). Age ≥ 65 years (odds ratio [OR]: 5.25, p = 0.001), PCI ≥ 24 (OR: 3.89, p = 0.006), and stage IV (OR: 3.28, p = 0.017) were associated with a higher likelihood of delay. After adjusting for stage, comorbidities, complete cytoreduction (CC)-score, and CRS type, there were no significant differences in progression-free or overall (OS) survival between groups. Subgroup analysis found early chemotherapy worsened OS in CC-0 patients (p = 0.017), while CC-1 patients demonstrated a non-significant trend towards improved OS.

Conclusion

Older OC patients with high tumor burden are more likely to have AC delay after CRS/HIPEC. Without clear survival benefits from early AC initiation, time to chemotherapy may be based on individual patient characteristics.