title: Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study.
abstract: OBJECTIVE
  In Denmark, the proportion of women with ovarian cancer treated with neoadjuvant chemotherapy (NACT) has increased, and the use of NACT varies among center hospitals. We aimed to evaluate the impact of first-line treatment on surgical outcome and median overall survival (MOS).
  
  
  METHODS
  All patients treated in Danish referral centers with stage IIIC or IV epithelial ovarian cancer from January 2005 to October 2011 were included. Data were obtained from the Danish Gynecological Cancer Database, the Danish National Patient Register and medical records.
  
  
  RESULTS
  Of the 1677 eligible patients, 990 (59%) were treated with primary debulking surgery (PDS), 515 (31%) with NACT, and 172 (10%) received palliative treatment. Of the patients referred to NACT, 335 (65%) received interval debulking surgery (IDS). Patients treated with NACT-IDS had shorter operation times, less blood loss, less extensive surgery, fewer intraoperative complications and a lower frequency of residual tumor (p < 0.05 for all). No difference in MOS was found between patients treated with PDS (31.9 months) and patients treated with NACT-IDS (29.4 months), p = 0.099. Patients without residual tumor after surgery had better MOS when treated with PDS compared with NACT-IDS (55.5 and 36.7 months, respectively, p = 0.002). In a multivariate analysis, NACT-IDS was associated with increased risk of death after two years of follow-up (HR: 1.81; CI: 1.39-2.35).
  
  
  CONCLUSIONS
  No difference in MOS was observed between PDS and NACT-IDS. However, patients without residual tumor had superior MOS when treated with PDS, and NACT-IDS could be associated with increased risk of death after two years of follow-up.
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark. Electronic address: carstenlo@gmail.com.
authors: Carsten Lindberg
authors: CL
authors: Fagö-Olsen
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Bent
authors: B
authors: Ottesen
authors: Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Henrik
authors: H
authors: Kehlet
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Sofie L
authors: SL
authors: Antonsen
authors: The Finsen Laboratory and Biotech Research and Innovation Center (BRIC), Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Ib J
authors: IJ
authors: Christensen
authors: Department of Gynecology and Obstetrics, Odense University Hospital, Denmark.
authors: Algirdas
authors: A
authors: Markauskas
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Gynecology and Obstetrics, Herlev Hospital, Copenhagen University Hospital, Denmark.
authors: Berit J
authors: BJ
authors: Mosgaard
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Christian
authors: C
authors: Ottosen
authors: Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark.
authors: Charlotte H
authors: CH
authors: Soegaard
authors: Department of Gynecology and Obstetrics, Aalborg University Hospital, Denmark.
authors: Erik
authors: E
authors: Soegaard-Andersen
authors: Department of Gynecology and Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors: Claus
authors: C
authors: Hoegdall
mesh_terms: D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Neoadjuvant chemotherapy; Ovarian cancer; Overall survival; Primary debulking surgery; Surgical outcome