Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: A retrospective study from the ESME national cohort

Quentin Dominique Thomas (1) , Amal Boussere (1) , Jean-Marc Classe (2) , Christophe Pomel (3, 4) , Hélène Costaz (5) , Manuel Rodrigues (6) , Isabelle Ray-Coquard (7) , Laurence Gladieff (8) , Roman Rouzier (9) , Thibault de la Motte Rouge (10) , Sébastien Gouy (11) , Emmanuel Barranger (12) , Renaud Sabatier (13) , Anne Floquet (14) , Frédéric Marchal (15) , Cécile Guillemet (16) , Valentine Polivka (1) , Anne-Laure Martin (17) , Pierre-Emmanuel Colombo (1) , Frédéric Fiteni (18, 19)

1 ICM - Institut régional de Cancérologie de Montpellier
2 CRLCC René Gauducheau
3 IMoST - Imagerie Moléculaire et Stratégies Théranostiques
4 UNICANCER/CJP - Centre Jean Perrin [Clermont-Ferrand]
5 Service de chirurgie [Centre Georges-François Leclerc]
6 Institut Curie [Paris]
7 Centre Léon Bérard [Lyon]
8 ICR - Institut Claudius Regaud
9 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
10 CRLCC - CRLCC Eugène Marquis
11 IGR - Institut Gustave Roussy
12 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
13 IPC - Institut Paoli-Calmettes
14 Institut Bergonié [Bordeaux]
15 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
16 CLCC Henri Becquerel - Centre de Lutte Contre le Cancer Henri Becquerel Normandie Rouen
17 UNICANCER
18 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
19 IDESP - Institut Desbrest de santé publique

Objective. Interval debulking surgery is recommended after 3–4 cycles (standard IDS) of neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer (EOC) not able to received upfront complete debulking surgery. However, real world practices frequently report performing IDS after ≥5 NAC cycles (delayed IDS). The aim of this work was to evaluate the impact on survival of the number of NACT cycles before IDS. Methods. We identified from a French national database, women with newly diagnosed EOC who underwent IDS from January 2011 to December 2016. Progression free survival (PFS) and overall survival (OS) were compared using Cox model with adjustments for confounding factors provided by two propensity score methods: inverse probability of treatment weighting (IPTW) and matched-pair analysis. Results. 928 patients treated by IDS for which our propensity score could be applied were identified. After a median follow-up of 49.0 months (95% CI [46.0;52.9]); from the IPTW analysis, median PFS was 17.6 months and 11.5 months (HR = 1.42; CI 95% [1.22–1.67]; p < 0.0001); median OS was 51.2 months and 44.3 months (HR = 1.29; CI 95% [1.06–1.56]; p = 0.0095) for the standard and delayed IDS groups. From the matched-pair analysis (comparing 352 patients for each group), standard IDS was associated with better PFS (HR = 0,77; CI 95% [0.65–0.90]; p = 0.018) but not significantly associated with better OS (HR = 0,84; CI 95% [0.68–1,03]; p = 0.0947). Conclusions. Carrying IDS after ≥5 NACT cycles seems to have a negative effect on patients survival. The goal of IDS surgery is complete resection and should not be performed after >3–4 NACT cycles.

Mots clés: Neoadjuvant; Cytoreduction; Survival; Prognosis; Propensity score

Domaines: Cancer

Quentin Dominique Thomas, Amal Boussere, Jean-Marc Classe, Christophe Pomel, Hélène Costaz, et al.. Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: A retrospective study from the ESME national cohort. Gynecologic Oncology, 2022, 167 (1), pp.11-21. ⟨10.1016/j.ygyno.2022.08.005⟩. ⟨hal-03868125⟩