Primary vs. interval cytoreduction for high-grade serous ovarian cancer: oncological outcomes from a retrospective study at a single tertiary referral center

High-grade serous carcinomas are the most prevalent subtype of ovarian cancer. While primary debulking surgery (PDS) remains as standard approach, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative for certain patients. Our study aims to compare the oncological outcomes of these strategies in our clinic. Our retrospective study involves the patients diagnosed with advanced stage high-grade serous ovarian cancer (HGSOC) at Hacettepe University Gynecologic Oncology Clinic from January 2014 to May 2021. Patients were categorized into two groups: PDS group and NACT/IDS group. We conducted a comparison between these groups, analyzing patient characteristics, staging and subsequent oncological follow-up outcomes. A total of 151 patients were enrolled in study population, with the PDS group consisting of 77 patients whereas the NACT/IDS group 74. The median follow-up period of our study was determined as 45 months. The median overall survival (OS) of the study population was determined to be 54 months, and the median progression-free survival (PFS) was 11 months. Accordingly, our study involved an attempt to identify independent variables that may have an impact on OS and PFS. Multivariate analysis confirmed that achieving “no residual tumor after surgery” directly influences OS rates (Hazard Ratio (HR): 0.57 (95% Confidence Interval (CI) 0.34–0.96); p = 0.034). Regarding overall survival (HR: 0.74 (95% CI 0.45–1.22); log rank p = 0.234) and progression-free survival (HR: 0.728 (95% CI 0.50–1.06); log rank p = 0.083), it was demonstrated that both strategies yield comparable oncological outcomes. Furthermore, the impact of pandemic on the preference of treatment strategy has also been evaluated. NACT/IDS and PDS strategies have comparable oncological outcomes, in terms of surgical complications, recurrence and survival rates. However, if it is envisaged that no residual disease after surgery with appropriate patient selection, PDS strategy can be considered as leading option.

Ovarian cancer; Neoadjuvant therapy; Gynecologic surgical procedures

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