Seagle BLL, et al. - A national cancer database study is performed to compare overall survival (OS) of women with advanced ovarian cancer treated with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC). It was concluded that the primary debulking surgery was related to increased OS among women with stage III but not stage IV ovarian cancer in a nationally representative cohort with low NAC use. If this finding reflects treatment assignment bias, it recommends that providers often well select candidates for PDS rather than NAC, although median OS times remain low.

Methods

• For this study, they queried 1998-2011 National Cancer Database to identify women with stage III or IV ovarian cancer treated with multiagent chemotherapy and stage-appropriate surgery.
• In this study, overall survival was estimated and compared utilizing Kaplan-Meier examination between women who received PDS followed by multiagent chemotherapy or NAC followed by interval surgery.
• Multivariable Cox proportional hazards regression model tested for relationship of potential explanatory variables with OS.
• Analyzed confounders included age, composite comorbidity scores, stage, grade, histology, insurance status, income quartile, and race.

Results

• Overall, 44,907 women (85.9%) underwent PDS, and 7348 women (14.1%) received NAC. Women who received NAC were older (64 vs 61 years, P < 0.001), had higher comorbidity scores (P< 0.001), and more often had stage IV disease (44.1% vs 26.1%, P < 0.001).
• Median OS was 41.1 (40.5-41.7) months among women who underwent PDS compared with 30.3 (29.3-31.1) months among women who received NAC (log-rank, P < 0.001).
• Among women with stage III disease, PDS was related to increased OS compared with NAC (median OS, 44.9 [44.2-45.7] vs 31.4 [30.2-33.0] months; hazard ratio [95% confidence interval], 0.70 [0.66-0.76]; P < 0.001).
• Among women with stage IV disease, no OS difference was seen between PDS and NAC cohorts (median OS, 31.2 [30.4-32.3] vs 28.4 [27.2-30.2] months; hazard ratio [95% confidence interval], 0.93 [0.85-1.02]; P = 0.12).