Comparison of primary debulking surgery and neoadjuvant chemotherapy plus interval debulking surgery for epithelial ovarian cancer with extra-abdominal metastasis

Background: Primary debulking surgery (PDS) or neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) was the standard treatment for advanced ovarian cancer. Optimal cytoreduction is believed one of the most important factors for survival. However, in patients with extra-abdominal metastases which is impossible to achieve optimal cytoreduction around whole body, which treatment should be used is not clear yet. Methods Patients with stage IV epithelial ovarian cancer with extra-abdominal metastases who underwent primary treatment between January 1, 2015 and January 31, 2022 were identified. Data were retrospectively extracted. Each patient record was evaluated to subclassify stage IV disease according to the sites of metastases at the time of diagnosis. Kaplan-Meier plot and Log-rank test were used to analyze the difference between two groups. Univariate and multivariate Cox regression analysis were used to identify important prognostic factors. Results A total of 72 newly diagnosed stage IV epithelial ovarian cancer patients were included, in which 36 (50%) patients underwent PDS, 36 (50%) patients underwent NACT-IDS. The median overall survival was significantly longer in PDS group than NACT-IDS group (51.3 months vs. 36 months, p = 0.027). Patients receiving PDS has significantly longer progression-free survival than who received NACT-IDS (21.6 months vs. 14.3 months, p = 0.049). The rate of no residual disease was higher in patients with NACT-IDS versus PDS (61% vs. 44%). The complete response rate was significantly higher in PDS group than NACT group (83% vs. 67%, p = 0.013) after PDS/IDS and full course of chemotherapy. Women who received PDS had a trend toward a higher rate of grade III/IV postoperative complications than those who received NACT (25% vs. 6%, p = 0.046). Conclusions. PDS for epithelial ovarian cancer patients with extra-abdominal metastasis resulted in longer OS and PFS than NACT + IDS. Cytoreduction to no residual disease in the interval debulking surgery should be the goal in patients who receive NACT.