[en] [en] OBJECTIVE: This study aimed to compare 5-year overall survival between primary debulking surgery and neoadjuvant chemotherapy followed by interval surgery in patients with stage IIIB to IVB epithelial ovarian cancer, using global real-world data. Secondary objectives included evaluation of progression-free survival and the influence of race, post-operative complications, and residual disease.
METHODS: SUROVA is a retrospective, international cohort study involving patients treated between 2018 and 2019 across 174 centers in 55 countries. Patients underwent primary surgery or received neoadjuvant chemotherapy followed by interval surgery, per institutional protocols. Propensity score matching was based on 7 baseline variables: age, race, Eastern Cooperative Oncology Group performance status at diagnosis, CA125 level at diagnosis, FIGO (International Federation of Gynecology and Obstetrics) stage IV disease, presence of ascites, and final tumor grade. Cox regression models with time-dependent effects and interaction terms were applied. A clinical risk calculator was developed and internally validated.
RESULTS: A total of 3286 patients had a mean age of 60.0 years (SD 12); 2978 (90.6%) had high-grade serous carcinoma, and 795 (24.7%) presented with FIGO stage IV disease. A total of 1666 patients (50.7%) underwent primary cytoreductive surgery, and 1620 (49.3%) received neoadjuvant chemotherapy. The median follow-up duration was 43.8 months (interquartile range; 22.6-59.3). After propensity score matching (n=1524), overall survival was similar between groups (67.2 vs 65.0 months; HR 1.002, 95% CI 0.85 to 1.18, p=.98). Outcomes differed by ethnicity, residual disease, and post-operative complications. Post-operative complications (28%) significantly worsened survival (66 vs 46 months; HR 1.5, 95% CI 1.2 to 1.9, p<.001), especially among patients undergoing primary surgery (73 vs 46 months; HR 1.85, 95% CI 1.43 to 2.37, p<.001). The most favorable outcomes were observed among patients with primary surgery, complete resection, and no complications, with median overall survival not reached (HR 1.25, 95% CI 1.12 to 1.40, p<.001).
CONCLUSIONS: Although overall survival was similar between groups, treatment effects differed by ethnicity, residual disease, and complications. Post-operative complications were associated with significantly worse survival, particularly among patients undergoing primary surgery, while the best outcomes were achieved in those who had primary surgery with complete resection and no complications.
Disciplines :
Surgery Reproductive medicine (gynecology, andrology, obstetrics) Oncology
Author, co-author :
Chiva, Luis; Cancer Center Universidad de Navarra, Madrid, Spain. Electronic address: lchiva@unav.es
Ordas, Pilar; Cancer Center Universidad de Navarra, Madrid, Spain
Mishra, Jagannath; Tata Medical Center, Kolkata, India
Ayhan, Ali; Başkent University, Turkish Society of Gynecologic Oncology (TRSGO), Ankara, Türkiye
Lee, Yoo-Young; Samsung Medical Center, Seoul, South Korea
Bogani, Giorgio; IRCCS National Cancer Institute, Milano, Italy
Sp, Somashekhar; Aster International Institute of Oncology, Bengaluru, India
Lomnytska, Marta; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
Stukan, Maciej; Pomeranian Hospitals, Department of Gynecological Oncology, Gdynia, Poland
Fruscio, Robert; Fondazione IRCCS San Gerardo dei Tintori, Clinic of Obstetrics and Gynecology, Monza, Italy
Chura, Bernabe Fora; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
Salcedo-Hernandez, Rosa A; National Institute of Cancerology Mexico, Gynecology Oncology Center, Mexico City, Mexico
De Iaco, Pierandrea; IRCCS Azienda Ospedaliero Universitaria di Bologna, Division of Oncologic Gynecology, Bologna, Italy
Haidopoulos, Dimitrios; National and Kapodistrian University of Athens, Athens, Greece
Svintsitskiy, Valentyn; National Cancer Institute, Kyiv, Ukraine
Jain, Vandana; Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
Stanciu, Paul; West Hertfordshire Teaching Hospitals NHS Trust, Watford, United Kingdom
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