Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?

A nationwide Danish study

Carsten Lindberg Fagö-Olsen, Bent Ottesen, Henrik Kehlet, Sofie L Antonsen, Ib Jarle Christensen, Algirdas Markauskas, Berit J Mosgaard, Christian Ottosen, Charlotte H Soegaard, Erik Soegaard-Andersen, Claus Hoegdall

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftGynecologic Oncology
Vol/bind132
Udgave nummer2
Sider (fra-til)292-8
ISSN0090-8258
DOI
StatusUdgivet - feb. 2014

Fingeraftryk

Ovarian Neoplasms
Residual Neoplasm
Denmark
Palliative Care
Medical Records
Referral and Consultation
Multivariate Analysis
Databases

Citer dette

Fagö-Olsen, C. L., Ottesen, B., Kehlet, H., Antonsen, S. L., Christensen, I. J., Markauskas, A., ... Hoegdall, C. (2014). Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. Gynecologic Oncology, 132(2), 292-8. https://doi.org/10.1016/j.ygyno.2013.11.035
Fagö-Olsen, Carsten Lindberg ; Ottesen, Bent ; Kehlet, Henrik ; Antonsen, Sofie L ; Christensen, Ib Jarle ; Markauskas, Algirdas ; Mosgaard, Berit J ; Ottosen, Christian ; Soegaard, Charlotte H ; Soegaard-Andersen, Erik ; Hoegdall, Claus. / Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. I: Gynecologic Oncology. 2014 ; Bind 132, Nr. 2. s. 292-8.
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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.",
keywords = "Aged, Chemotherapy, Adjuvant, Cohort Studies, Denmark, Female, Humans, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Neoplasms, Glandular and Epithelial, Ovarian Neoplasms, Retrospective Studies, Survivors, Treatment Outcome",
author = "Fag{\"o}-Olsen, {Carsten Lindberg} and Bent Ottesen and Henrik Kehlet and Antonsen, {Sofie L} and Christensen, {Ib Jarle} and Algirdas Markauskas and Mosgaard, {Berit J} and Christian Ottosen and Soegaard, {Charlotte H} and Erik Soegaard-Andersen and Claus Hoegdall",
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year = "2014",
month = "2",
doi = "10.1016/j.ygyno.2013.11.035",
language = "English",
volume = "132",
pages = "292--8",
journal = "Gynecologic Oncology",
issn = "0090-8258",
publisher = "Heinemann",
number = "2",

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Fagö-Olsen, CL, Ottesen, B, Kehlet, H, Antonsen, SL, Christensen, IJ, Markauskas, A, Mosgaard, BJ, Ottosen, C, Soegaard, CH, Soegaard-Andersen, E & Hoegdall, C 2014, 'Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study', Gynecologic Oncology, bind 132, nr. 2, s. 292-8. https://doi.org/10.1016/j.ygyno.2013.11.035

Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients? A nationwide Danish study. / Fagö-Olsen, Carsten Lindberg; Ottesen, Bent; Kehlet, Henrik; Antonsen, Sofie L; Christensen, Ib Jarle; Markauskas, Algirdas; Mosgaard, Berit J; Ottosen, Christian; Soegaard, Charlotte H; Soegaard-Andersen, Erik; Hoegdall, Claus.

I: Gynecologic Oncology, Bind 132, Nr. 2, 02.2014, s. 292-8.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Does neoadjuvant chemotherapy impair long-term survival for ovarian cancer patients?

T2 - A nationwide Danish study

AU - Fagö-Olsen, Carsten Lindberg

AU - Ottesen, Bent

AU - Kehlet, Henrik

AU - Antonsen, Sofie L

AU - Christensen, Ib Jarle

AU - Markauskas, Algirdas

AU - Mosgaard, Berit J

AU - Ottosen, Christian

AU - Soegaard, Charlotte H

AU - Soegaard-Andersen, Erik

AU - Hoegdall, Claus

N1 - Copyright © 2013 Elsevier Inc. All rights reserved.

PY - 2014/2

Y1 - 2014/2

N2 - 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.

AB - 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.

KW - Aged

KW - Chemotherapy, Adjuvant

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Humans

KW - Middle Aged

KW - Neoadjuvant Therapy

KW - Neoplasm Staging

KW - Neoplasms, Glandular and Epithelial

KW - Ovarian Neoplasms

KW - Retrospective Studies

KW - Survivors

KW - Treatment Outcome

U2 - 10.1016/j.ygyno.2013.11.035

DO - 10.1016/j.ygyno.2013.11.035

M3 - Journal article

VL - 132

SP - 292

EP - 298

JO - Gynecologic Oncology

JF - Gynecologic Oncology

SN - 0090-8258

IS - 2

ER -