Factors associated with declining cytoreductive surgery in advanced epithelial ovarian cancer: a population-based study.

Objective: Cytoreductive surgery serves as a cornerstone intervention for advanced epithelial ovarian cancer (EOC), yet some patients decline the procedure despite clinical recommendations. This study aimed to evaluate survival outcomes and identify sociodemographic and clinical factors associated with this decision in advanced EOC patients.

Methods: A retrospective analysis of EOC cases from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021) was conducted, including patients with stage III/IV EOC recommended for surgery. Patients were categorized into surgical and non-surgical cohorts. Propensity Score Matching (PSM) was applied to adjust for baseline differences, and survival outcomes were compared using Kaplan-Meier and Cox proportional hazards models. Logistic regression analysis was performed to identify predictors of surgery declination.

Results: Of the 21,988 patients included, 363 (1.7%) were in the non-surgery group. Following a median follow-up of 33 months, patients in the non-surgical cohort demonstrated significantly lower overall survival (OS) compared to the surgical cohort, with mean OS of 17.8 months versus 45.8 months, respectively (P < 0.001). The Cox model showed increased mortality risk for the non-surgical group post-PSM (HR, 1.87; 95% CI, 1.62-2.15). Non-Hispanic Black, older age, lower household income, nonmetropolitan residence, and unmarried status were associated with higher odds of surgery refusal.

Conclusion: Declining surgery is associated with significantly poorer survival in advanced EOC. Sociodemographic factors play a key role in surgical decision-making, underscoring the need for targeted interventions to improve access to surgical care and reduce disparities in EOC treatment outcomes. Further studies should explore the impact of specific chemotherapy and comorbidities on surgery refusal and survival.