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Chemotherapy alone for patients 75 years and older with epithelial ovarian cancer - is interval cytoreductive surgery still needed?

D. A. Klein,A. Mann,A. Freeman,C. Liao,D. Kapp,J. Chan

Published 2020 in American Journal of Obstetrics and Gynecology

ABSTRACT

BACKGROUND Ovarian cancer patients ≥ 75 years old experience high peri-operative morbidity, but recruitment into prospective trials to assess the role of surgery continues to be challenging. OBJECTIVE To compare overall survival for ovarian cancer patients ≥75 years old after chemotherapy alone vs. neoadjuvant chemotherapy with interval cytoreductive surgery (NACT). STUDY DESIGN Data were extracted from the National Cancer Data Base from 2004 to 2014. Kaplan-Meier and Cox proportional hazards models were used for statistical analyses. RESULTS Of 1,661 patients (median age: 79 years), most were White (88%) and had stage III-IV disease (95%), and 51% had serous histology. Of those who did not receive primary surgery, 58% had chemotherapy alone and the remainder had NACT. The use of NACT increased from 28% to 50% in years 2004-2007 to 2012-2014 (p<0.001). Compared to NACT, chemotherapy only patients were older (80 vs. 78 years; p<0.001) and had more advanced stage disease (98% vs. 91%; p<0.001). The 5-year overall survival of the entire study group was 14%; those who underwent NACT had associated survival of 25% compared to only 7% in chemotherapy alone group (p<0.001). In multivariable analysis, NACT (HR=0.44, 95% CI: 0.36-0.54; p<0.001) was an independent predictor for improved survival. Older (80-84 years) age (HR=1.35, 95% CI: 1.12-1.63; p=0.002), advanced (stage III-IV) disease (HR=2.06, 95% CI: 1.37-3.09; p=0.001), and clear cell histology (HR=2.17, 95% CI: 1.10-4.28; p=0.03) portended for worse outcome. CONCLUSION Ovarian cancer patients ≥75 years old have an overall poor prognosis. Receiving neoadjuvant chemotherapy followed by interval cytoreductive surgery is associated with higher overall survival compared to chemotherapy alone.

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