Comparison of the Outcome and Survival between Neoadjuvant Chemotherapy and Primary Surgery in Advanced Stage Ovarian Cancer, Fallopian Tube Cancer and Peritoneal Cancer: Propensity Score Methods
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Abstract
BACKGROUND: Ovarian cancer is the second most common gynecological malignancy, but is the most common cause of death in this form of malignancy. This was because almost all cases were in an advanced stage on the first visit and had delayed hospitalization due to the late symptoms.
OBJECTIVES: The aim was to compare the treatment outcome and survival between neoadjuvant chemotherapy (NACT) and primary surgery in advanced stage ovarian cancer, fallopian tube cancer, and peritoneal cancer.
METHODS: This study was therapeutic research with a retrospective cohort design of Stages III-IV ovarian cancer, fallopian tube cancer, and peritoneal cancer. The participants underwent treatment at the Oncologic Gynecology Unit, Surin Hospital, Thailand from January 1, 2011 to April 30, 2021 with a follow-up to November 30, 2021. The patients were classified into two groups: the NACT group and primary surgery group. The data of the baseline characteristics, stage, ECOG, CA125 level on the first diagnosis, cell type cancer, tumor grade, ascites, and chemotherapy regimen were collected. The data were analysed with multivariable binary risk regression, propensity score analysis, and covariate modeling.
RESULTS: A total of 220 patients consisted of 87 patients in the NACT group and 133 patients in the primary surgery group. The NACT group had a mean age of 56.8 years, which was greater than that of the primary surgery group (52.7 years.). The mean propensity score of the NACT group was 0.6±0.3, and the primary surgery group was 0.3±0.2. The NACT group had complete remission that was less than the primary surgery group (37.9% vs 68.4%), but also had partial or stable remissions and more deaths than the primary surgery group. There were no significant differences after adjusting the propensity score, and the NACT group tended to display more complete remission.
CONCLUSIONS: Treatment of advanced ovarian cancer, fallopian tube cancer, and peritoneal cancer was provided to both the NACT or primary surgery groups because after adjusting the propensity score, there were no significant differences in the complete, partial, or stable remissions and deaths.
Thaiclinicaltrials.org number, TCTR20220225007
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