Impact of neoadjuvant chemotherapy on the survival of patients with stage IIIc and IV epithelial ovarian cancer

Objective To compare the survival of patients with stage mc or IV epithelial ovarian cancer treated either with neoadjuvantchemotherapy （NAC） followed by cytoreductive surgery or primary cytoreductive surgery （PCS） followed by adjuvant chemotherapy. Methods The clinical and pathological data of 160 patients with stage lllc or IV epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed. Forty-two patients were treated with NAC followed by cytoreductive surgery （ NAC group ） and 1 1 8 patients with PCS followed by adjuvant chemotherapy （ PCA group ）. Results The overall response rate of NAC group was 69.1%. No significant difference was observed between the NAC group and PCS group in operating time, intra-operative blood loss and units of blood-transfusion （ P 〉 0.05 ）. Optimal cytoreductive surgery was performed in 88.1% of NAC group versus in 71.2% of PCS group （ P 〈 0.05 ）. In those who had optimal cytoreductive surgery, the recurrent rate was 43.2% in NAC group versus 56.0% in PCS group without significant difference between two groups （ P 〉 0. 05 ）. The disease-free survival and progression-free survival was 7 and 8 months in NAC group, which were significantly shorter than 13 and 18 months in PCS group （P 〈0.05 ）, however, the median overall survival （OS） was 34 mouths in NAC group versus 43 months in PCS group without significant difference（ P 〉0.05 ）. In the patients with optimal cytoreductive surgery, it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups （ P 〉 0.05）. Conclusion Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stage III c or IV epithelial ovarian cancer, but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adiuvant chemotherapy. Key words: Ovarian neoplasms;  Neoadjuvant chemotherapy;  Cytoreductive surgery ;  Survival