title: Multiple Cycles of Neoadjuvant Chemotherapy Associated With Poor Survival in Bulky Stage IIIC and IV Ovarian Cancer.
abstract: OBJECTIVE
  The aim of this study was to determine the impact of neoadjuvant chemotherapy (NACT) on survival in patients with bulky stage IIIC and IV epithelial ovarian cancer.
  
  
  METHODS
  Between January 2009 and December 2012, 408 patients with ovarian cancer with extensive upper abdominal disease were reviewed. On the basis of the cycle number of NACT, patients were divided into 2 groups, namely, primary debulking surgery (PDS) group, which included the patients who received no more than 1 cycle of NACT; and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) group, which included the patients who received more than 1 cycle of NACT. All patients underwent cytoreductive surgery with the goal of optimal outcome (≤1 cm). Progression-free survival and overall survival were evaluated.
  
  
  RESULTS
  There was no difference in surgical outcomes between PDS and NACT-IDS group, which was evaluated with either complete cytoreduction (41/376, 10.9% vs 6/32, 18.8%) or optimal cytoreduction (201/376, 53.5% vs 18/32, 56.2%). The median survival was 43.0 and 27.3 months in the PDS group and NACT-IDS group, with an estimated 5-year survival of 36% and 31%, respectively (P = 0.032; hazard ratio, 0.59; 95% confidence interval, 0.36-0.95). Complete cytoreduction, without bowel mesenteric carcinomatosis, and no more than 1 cycle of NACT were associated with lengthened survival by the multivariate analysis (P = 0.012, 0.025, and 0.036, respectively).
  
  
  CONCLUSIONS
  Neoadjuvant chemotherapy was associated with poor survival of patients with bulky stage IIIC and IV ovarian cancer. A well-designed randomized trial with a better quality control of surgical procedures is needed to confirm the results.
authors.affiliation: *Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center; and †Ovarian Cancer Program, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Fudan University Zhongshan Hospital, Shanghai, China.
authors.forename: Yulan
authors.initials: Y
authors.lastname: Ren
authors.forename: Tingyan
authors.initials: T
authors.lastname: Shi
authors.forename: Rong
authors.initials: R
authors.lastname: Jiang
authors.forename: Sheng
authors.initials: S
authors.lastname: Yin
authors.forename: Pan
authors.initials: P
authors.lastname: Wang
authors.forename: Rongyu
authors.initials: R
authors.lastname: Zang
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate