Surgical outcomes and prognostic factors of neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer.

Abstract

Objective: To investigate the surgical outcomes and prognostic factors of neoadjuvant chemotherapy (NACT) combined with interval debulking surgery (IDS) in patients with advanced ovarian cancer.

Methods: A retrospective analysis was conducted on clinical data of 97 patients with advanced ovarian cancer admitted to Xijing Hospital of The Fourth Military Medical University from January 2018 to December 2019. The patients were divided into two groups based on their treatment methods: a control group (primary debulking surgery (PDS), n=48) and an observation group (NACT combined with IDS, n=49). Short-term efficacy, perioperative outcomes, tumor markers, immune function, quality of life, adverse reactions, and survival status were compared between the two groups. Factors affecting prognosis were analyzed, a Nomogram prediction model was constructed and validated.

Results: The observation group demonstrated superior short-term efficacy than the control group, with lower intraoperative blood loss, shorter hospitalization duration, and reduced transfusion volume (P<0.05). After treatment, tumor marker levels, immune function, and quality of life improved significantly in both groups compared to pre-treatment levels, with more pronounced improvements in the observation group (P<0.05). The incidence of adverse reactions such as liver injury, kidney injury, nausea and vomiting, and myelosuppression was lower in the observation group than in the control group (P<0.05). Additionally, no significant difference in 5-year progression-free survival (PFS) and overall survival (OS) was observed between the two groups (P>0.05). Univariate and multivariate regression analyses identified age ≥50 years, tumor size >10 cm, low differentiation, PDS, and presence of residual lesions as independent prognostic factors. The Nomogram prediction model achieved an AUC of 0.955 (95% CI: 0.917-0.993), with calibration curves closely aligning with the ideal line, indicating high predictive accuracy and reliability.

Conclusion: NACT combined with IDS demonstrated superior short-term efficacy compared to traditional PDS in patients with advanced ovarian cancer, with improved perioperative conditions, reduced adverse reactions, and enhanced survival rates. Age, tumor size, histological differentiation, and treatment modality independently affect patient prognosis. The Nomogram prediction model developed in this study demonstrates excellent discriminative power and clinical applicability for prognostic evaluation.