title: The optimal time for surgery in women with serous ovarian cancer.
abstract: BACKGROUND
  Advanced high-grade serous ovarian carcinoma (HGSC) is commonly treated with surgery and chemotherapy. We investigated the survival of patients treated with primary or interval surgery at different times following neoadjuvant chemotherapy. Their survival was compared with that of patients treated with primary cytoreductive surgery and adjuvant chemotherapy.
  
  
  METHODS
  Patients with stage III or IV HGSC were included in this retrospective cohort study. Clinical data were obtained from patient records. Patients were divided into 2 groups based on treatment with neoadjuvant chemotherapy and interval cytoreductive surgery (NAC) or with primary cytoreductive surgery and adjuvant chemotherapy (PCS). Study groups were stratified by several clinical variables.
  
  
  RESULTS
  We included 334 patients in our study: 156 in the NAC and 178 in the PCS groups. Survival of patients in the NAC group was independent of when they underwent interval cytoreductive surgery following initiation of neoadjuvant chemotherapy (p < 0.001). Optimal surgical cytoreduction had no impact on overall survival in the NAC group (p < 0.001). Optimal cytoreduction (p < 0.001) and platinum sensitivity (p < 0.001) were independent predictors of improved survival in the PCS but not in the NAC group. Patients in the NAC group had significantly worse overall survival than those in the PCS group (31.6 v. 61.3 mo, p < 0.001).
  
  
  CONCLUSIONS
  Women with advanced HGSC who underwent PCS had better survival than those who underwent interval NAC, regardless of the number of cycles of neoadjuvant therapy. Optimal cytoreduction did not provide a survival advantage in the NAC group.
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Jocelyn M
authors.initials: JM
authors.lastname: Stewart
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Alicia A
authors.initials: AA
authors.lastname: Tone
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Haiyan
authors.initials: H
authors.lastname: Jiang
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Marcus Q
authors.initials: MQ
authors.lastname: Bernardini
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Sarah
authors.initials: S
authors.lastname: Ferguson
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Stephane
authors.initials: S
authors.lastname: Laframboise
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: K Joan
authors.initials: KJ
authors.lastname: Murphy
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Barry
authors.initials: B
authors.lastname: Rosen
authors.affiliation: From the Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ont. (Stewart, Tone, Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); the Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ont. (Bernardini, Ferguson, Laframboise, Murphy, Rosen, May); and the Department of Biostatistics, University of Toronto, Toronto, Ont. (Jiang).
authors.forename: Taymaa
authors.initials: T
authors.lastname: May
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010051:Ovarian Neoplasms / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies