Comparison of Neoadjuvant Chemotherapy Plus Interval Debulking Surgery and Primary Debulking Surgery in Patients with Stage III and IV Ovarian Carcinoma: A Multicenter Real Life Experience

OBJECTIVE The aim of the study is to compare treatment outcomes of the patients with federation of gynecology and obstetrics stages III and IV ovarian carcinomas, who underwent interval debulking surgery after neoadjuvant chemotherapy (NACT), and patients who underwent adjuvant chemotherapy after primary debulking surgery (PDS). METHODS Patients from four centers (n=183) were retrospectively evaluated. Of the patients, 91 (50%) were in the PDS group and 92 (50%) in the NACT group. RESULTS In the NACT group patients have advanced age, poor performance status, high levels of CA125, and advanced disease stage compared with the PDS group (p<0.050). Of the patients receiving NACT, 14 (15%) had a complete response, and 68 (74%) had a partial response. The R0 rate was higher in the PDS group (p=0.018). In univariate analysis, poor prognostic factors affecting OS were NACT in the treatment protocol (p<0.001), poor performance status (p<0.001), advanced age (<70 vs. >= 70, p=0.002), advanced clinical stage (p=0.042), and localization of the tumor with the largest diameter outside the omentum and ovary at the time of diagnosis (p=0.029). In the multivariate analysis, the presence of NACT (HR: 2.30, 95% CI: 1.25-4.23, p=0.007) and poor performance (HR: 2.52, 95% CI: 1.18-5.10, p=0.017) were independent poor prognostic factors for OS. CONCLUSION In the study, OS was better in the PDS group than in the NACT group. This result was thought to be associated with the NACT group having more disadvantageous characteristics (advanced age, poor performance, high CA125 level, advanced stage, etc.).