Ethical Statement for Collecting Clinical Information

This was a retrospective study. The study was carried out according to the Declaration of Helsinki, and written informed consent was obtained from all patients or their legal guardians. Ethical approval was obtained from the Institutional Review Board of the Zhongnan Hospital of Wuhan University.

Study Design and Patient Selection

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In a retrospective study, medical records were reviewed for 134 women diagnosed and treated for OCCC at Zhongnan Hospital of Wuhan University, Hubei Cancer Hospital, Chongqing Cancer Hospital, and Xiangyang Central Hospital from January 2012 to December 2017. Following the FIGO staging criteria (2014), stage I was considered an early-stage disease, while stages greater than stage I were classified as advanced disease. Experienced pathologists reviewed the pathological diagnoses. Patients who underwent surgical staging and were confirmed as OCCC, staged II–IV, along with complete follow-up information, were included for the study. Based on the study entry criteria, 85 cases were selected (Figure 1). Progression-free survival (PFS) was calculated as the number of months from the time of diagnosis to tumor progression or patient’s death, regardless of cause. Tumor progression was defined as tumor marker elevation, radiological or clinical recurrence, or pathological evidence after reoperation. Overall survival (OS) was calculated from the time of diagnosis to the patient’s death or the end of follow-up. The study was approved by the Institutional Review Board of Zhongnan Hospital of Wuhan University.

Figure 1

Follow-up data were collected from August 2017, with a median follow-up of 19 months (range, 3–75 months). Data on the clinical and pathologic characteristics of study patients were collected, including age, preoperative serum cancer antigen 125 (CA-125) level, ascitis, residual tumor size, stage, lymph node (LN) excision metastasis, and CT cycles underwent after cytoreductive surgery. For evaluation of the surgical effect, the ideal reduction was a diameter of ≤1 cm for postoperative residual tumor (R1), whereas a residual tumor size >1 cm (R2) was a non-ideal reduction, and residual tumor size of zero (R0) was considered complete reduction. Progression-free survival (PFS) was defined in months from the time of diagnosis to that of tumor progression, patient death, or the last follow-up. The criteria for tumor progression was to meet at least one of the following conditions: elevation of tumor markers, imaging recurrence, clinical symptoms, and pathological evidence after reoperation. Overall survival (OS) was defined as the time from diagnosis to the patient’s death or the end of follow-up.

Since the NCCN guidelines (2019) stated that “There is no evidence confirming that more than 6 cycles of combination chemotherapy are required for initial chemotherapy”, the outcomes of patients who underwent >6 versus ≤6 cycles of CT were compared.

Statistical Analysis

Data were analyzed using SPSS version 18.0. Kaplan-Meier survival analyses were performed to estimate PFS and OS, and the Log rank test was employed to compare the differences in survival functions. All P-values <0.05 were regarded as statistically significant.

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