Primary cytoreductive surgery was associated with improved survival compared with neoadjuvant chemotherapy in otherwise healthy women age 70 years or younger with advanced-stage epithelial ovarian cancer, according to findings published in JAMA Oncology.1

Because the benefits of primary cytoreductive surgery relative to neoadjuvant chemotherapy remain uncertain, researchers sought to compare overall survival of primary cytoreductive surgery with that of neoadjuvant chemotherapy in a large national population of women with advanced-stage epithelial ovarian cancer.

Investigators retrospectively analyzed data from 22,962 patients with stage IIIC and IV epithelial ovarian cancer diagnosed between 2003 and 2011 and treated at hospitals across the United States. Investigators matched 2935 patients age 70 years or younger with a Charlson comorbidity index of 0 who underwent neoadjuvant chemotherapy with similar patients who received primary cytoreductive surgery.

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At a median follow-up of 56.5 months (95% CI, 54.5-59.2) in the primary cytoreductive surgery group and 56.3 months (95% CI, 54.5-59.8) in the neoadjuvant chemotherapy group, results showed that median overall survival was 37.3 months (95% CI, 35.2-38.7) and 32.1 months (95% CI, 30.8-34.1), respectively. The difference in median overall survival was statistically significant between the 2 groups (P <.001).

However, researchers found that had the neoadjuvant chemotherapy group included a higher proportion of women with performance status of 1 to 2 vs those who underwent primary reduction surgery, there would be no significant association between surgery and improved survival.

Because the lower survival in women who received chemotherapy prior to surgery could be explained by a higher prevalence of limited performance status, future prospective studies are needed to determine the survival benefit of primary cytoreductive surgery vs neoadjuvant chemotherapy in this population.


1. Rauh-Hain JA, Melamed A, Wright A, et al. Overall survival following neoadjuvant chemotherapy vs primary cytoreductive surgery in women with epithelial ovarian cancer: analysis of the National Cancer Database. JAMA Oncol. 2016 Nov 17. doi: 10.1001/jamaoncol.2016.4411. [Epub ahead of print]