Introduction: The aim of this study was to compare the disease-free survival (DFS) and overall survival (OS) of patients who underwent interval cytoreductive surgery after 3–4 cycles or 6 cycles of neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer patients. Methods: Out of 219 patients with advanced epithelial ovarian cancer, 123 patients received 3–4 cycles and 96 patients received 6 cycles of platinum-based NACT. Afterward, laparotomy was performed for interval cytoreductive surgery. Results: No statistically significant difference was found for DFS and OS of the patients who received 3–4 cycles and those who received 6 cycles of NACT (HR: 1.047, 95.0% CI [0.779–1.407]; p: 0.746 for DFS, and HR: 1.181, 95.0% CI [0.818–1.707]; p: 0.368 for OS). Evaluating 123 patients who received 3–4 cycles of NACT, 87 patients (70.7%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS compared to 36 patients (29.3%) with any residual tumor (HR: 1.830, 95.0% CI [1.194–2.806]; p: 0.003 for DFS, and HR: 1.946, 95.0% CI [1.166–3.250]; p: 0.009 for OS). 96 patients who received 6 courses of NACT were evaluated; 63 patients (65.6%) without macroscopic residual tumor after interval cytoreductive surgery had significantly longer DFS and OS than 33 patients (34.4%) with any residual tumor (HR: 1.716, 9 5.0% CI [1.092–2.697]; p: 0.010 for DFS, and HR: 1.921, 95.0% CI [1.125–3.282]; p: 0.013 for OS). Conclusion: In patients with advanced ovarian cancer, there is no significant difference in DFS and OS between 3 and 4 cycles or 6 cycles of NACT. The most important factor determining survival is whether macroscopic residual tumor tissue remains after interval cytoreductive surgery following NACT.

1.
Siegel
R
,
Ward
E
,
Brawley
O
,
Jemal
A
.
Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths
.
CA Cancer J Clin
.
2011
;
61
(
4
):
212
36
. .
2.
American Cancer Society
.
Cancer facts and figures 2023
.
Atlanta (GA)
:
American Cancer Society
;
2023
.
3.
Bacry
MC
,
Philippe
AC
,
Riethmuller
D
,
Faucheron
JL
,
Pomel
C
.
Interval debulking surgery after neoadjuvant chemotherapy in advanced ovarian cancer-retrospective study comparing surgery after 3 cycles or more of chemotherapy
.
J Gynecol Obstet Hum Reprod
.
2022
;
51
(
7
):
102409
. .
4.
Berek
JS
,
Bast
RC
Jr
.
Epithelial ovarian cancer
. In:
Holland-frei cancer medicine
. 6th ed.
BC Decker
;
2003
. Available from: https://www.ncbi.nlm.nih.gov/books/NBK12433/.
5.
Devouassoux-Shisheboran
M
,
Genestie
C
.
Pathobiology of ovarian carcinomas
.
Chin J Cancer
.
2015
;
34
(
1
):
50
5
. .
6.
Wright
AA
,
Bohlke
K
,
Armstrong
DK
,
Bookman
MA
,
Cliby
WA
,
Coleman
RL
, et al
.
Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: society of Gynecologic Oncology and American Society of Clinical Oncology clinical practice guideline
.
Gynecol Oncol
.
2016
;
143
(
1
):
3
15
. .
7.
DiSilvestro
P
,
Banerjee
S
,
Colombo
N
,
Scambia
G
,
Kim
BG
,
Oaknin
A
, et al
.
Overall survival with maintenance olaparib at a 7-year follow-up in patients with newly diagnosed advanced ovarian cancer and a BRCA mutation:the SOLO1/GOG 3004 trial
.
J Clin Oncol
.
2023
;
41
(
3
):
609
17
. .
8.
Vincent
L
,
Jankowski
C
,
Ouldamer
L
,
Ballester
M
,
Bendifallah
S
,
Bolze
PA
, et al
.
Prognostic factors of overall survival for patients with FIGO stage IIIc or IVa ovarian cancer treated with neo-adjuvant chemotherapy followed by interval debulking surgery: a multicenter cohort analysis from the FRANCOGYN study group
.
Eur J Surg Oncol
.
2020
;
46
(
9
):
1689
96
. .
9.
Fagotti
A
,
Ferrandina
MG
,
Vizzielli
G
,
Pasciuto
T
,
Fanfani
F
,
Gallotta
V
, et al
.
Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850)
.
Int J Gynecol Cancer
.
2020
;
30
(
11
):
1657
64
. .
10.
Akladios
C
,
Baldauf
JJ
,
Marchal
F
,
Hummel
M
,
Rebstock
LE
,
Kurtz
JE
, et al
.
Does the number of neoadjuvant chemotherapy cycles before interval debulking surgery influence survival in advanced ovarian cancer
.
Oncology
.
2016
;
91
(
6
):
331
40
. .
11.
Thomas
QD
,
Boussere
A
,
Classe
JM
,
Pomel
C
,
Costaz
H
,
Rodrigues
M
, et al
.
Optimal timing of interval debulking surgery for advanced epithelial ovarian cancer: a retrospective study from the ESME national cohort
.
Gynecol Oncol
.
2022
;
167
(
1
):
11
21
. .
12.
Colombo
N
,
Sessa
C
,
du Bois
A
,
Ledermann
J
,
McCluggage
WG
,
McNeish
I
, et al
.
ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease
.
Ann Oncol
.
2019
;
30
(
5
):
672
705
. .
13.
Vergote
I
,
Tropé
CG
,
Amant
F
,
Kristensen
GB
,
Ehlen
T
,
Johnson
N
, et al
.
Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer
.
N Engl J Med
.
2010
;
363
(
10
):
943
53
. .
14.
Kehoe
S
,
Hook
J
,
Nankivell
M
,
Jayson
GC
,
Kitchener
H
,
Lopes
T
, et al
.
Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial
.
Lancet
.
2015
;
386
(
9990
):
249
57
. .
15.
Bristow
RE
,
Chi
DS
.
Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis
.
Gynecol Oncol
.
2006
;
103
(
3
):
1070
6
. .
16.
Minareci
Y
,
Sozen
H
,
Ak
N
,
Tosun
OA
,
Saip
P
,
Salihoglu
MY
, et al
.
Prolongation of neoadjuvant chemotherapy before surgery: seeking the optimal number of cycles in serous ovarian cancer
.
Chemotherapy
.
2022
;
67
(
1
):
1
11
. .
17.
Marchetti
C
,
Rosati
A
,
De Felice
F
,
Boccia
SM
,
Vertechy
L
,
Pavone
M
, et al
.
Optimizing the number of cycles of neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma: a propensity-score matching analysis
.
Gynecol Oncol
.
2021
;
163
(
1
):
29
35
. .
18.
Liu
YL
,
Zhou
QC
,
Iasonos
A
,
Chi
DS
,
Zivanovic
O
,
Sonoda
Y
, et al
.
Pre-operative neoadjuvant chemotherapy cycles and survival in newly diagnosed ovarian cancer: what is the optimal number? A memorial sloan kettering cancer center team ovary study
.
Int J Gynecol Cancer
.
2020
;
30
(
12
):
1915
21
. .
19.
Tate
S
,
Nishikimi
K
,
Kato
K
,
Matsuoka
A
,
Kambe
M
,
Kiyokawa
T
, et al
.
Microscopic diseases remain in initial disseminated sites after neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and primary peritoneal cancer
.
J Gynecol Oncol
.
2020
;
31
(
3
):
e34
. .
20.
Tate
S
,
Nishikimi
K
,
Matsuoka
A
,
Shozu
M
.
Aggressive surgery for advanced ovarian cancer decreases the risk of intraperitoneal recurrence
.
Int J Clin Oncol
.
2020
;
25
(
9
):
1726
35
. .
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