title: Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer.
abstract: OBJECTIVE
  Complete surgery with no macroscopic residual disease (RD) at primary (PDS) or interval debulking surgery (IDS) is the main objective of surgery in advanced epithelial ovarian cancer (EOC). The aim of this work was to evaluate the impact on survival of the number of neoadjuvant chemotherapy (NAC) cycles before IDS in EOC patients.
  
  
  METHODS
  Data from EOC patients (stages IIIC-IV), operated on between 1995 and 2010 were consecutively recorded. NAC/IDS patients were analyzed according to the number of preoperative cycles (<4=group B1; >4=group B2) and compared with patients receiving PDS (group A). Patients with complete resection were specifically analyzed.
  
  
  RESULTS
  367 patients were analyzed, 220 received PDS and 147 had IDS/NAC. In group B, 37 patients received more than 4 NAC cycles (group B2). Group B2 patients presented more frequently stage IV disease at diagnosis (p<0.01) compared to groups A and B1. The rate of complete cytoreduction was higher in group B (p<0.001). Patients with no RD after IDS and who had received more than 4 NAC cycles had poor survival (p<0.001) despite complete removal of their tumor (relative risk of death after multivariate analysis of 3 (p<0.001)) with an independent impact from disease stage and WHO performance status.
  
  
  CONCLUSIONS
  Patients with advanced EOC receiving complete IDS after more than 4cycles of NAC have poor prognosis. Despite worse prognostic factors observed in this group of patients, our study reinforces the concept of early and complete removal of all macroscopic tumors in the therapeutic sequence of EOC.
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France. Electronic address: Pierre-Emmanuel.Colombo@icm.unicancer.fr.
authors.forename: P E
authors.initials: PE
authors.lastname: Colombo
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Labaki
authors.affiliation: Department of Medical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Fabbro
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Bertrand
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: A
authors.initials: A
authors.lastname: Mourregot
authors.affiliation: Department of Medical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: M
authors.initials: M
authors.lastname: Gutowski
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: B
authors.initials: B
authors.lastname: Saint-Aubert
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: F
authors.initials: F
authors.lastname: Quenet
authors.affiliation: Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: P
authors.initials: P
authors.lastname: Rouanet
authors.affiliation: Department of Biostatistics, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
authors.forename: C
authors.initials: C
authors.lastname: Mollevi
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D000077216:Carcinoma, Ovarian Epithelial; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009375:Neoplasms, Glandular and Epithelial / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017239:Paclitaxel / Q000008:administration & dosage; D017671:Platinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017671:Platinum Compounds; D017239:Paclitaxel
keywords: Epithelial ovarian cancer; Interval surgery; Neoadjuvant chemotherapy; Number of cycles; Prognosis