Clinicopathological Factors Predicting Survival in Women with Advanced Ovarian Cancer Treated with NACT Followed by IDS - A Retrospective Study

Introduction: Ovarian cancer is mostly diagnosed at an advanced stage due to its initial asymptomatic nature. It is often associated with high morbidity and mortality. Neo-adjuvant chemotherapy followed by interval debulking surgery is the primary modality of treatment accepted now a days. Our study was conducted in these cases and predictors of survival evaluated.

Aims: To study the clinicopathological factors predicting outcome survival in women with advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).

Methods: A retrospective observational study was conducted over a period of two years from 1st January 2014 to 31st December 2015. All patients with serous epithelial ovarian tumors who received NACT (neo-adjuvant chemotherapy); 3 to 4 cycles followed by IDS (interval debulking surgery) followed by 3 cycles of adjuvant chemotherapy were studied. Factors influencing their overall survival were critically analyzed and evaluated.

Results: A retrospective study was conducted from 1st January 2014 to 31st December 2015; a total of 50 patients with carcinoma ovary were studied. All the patients belonged to stage III and above with a mean age of 46.16 years. All the patients had histopathology report of epithelial serous ovarian carcinoma and all the fifty patients received NACT followed by IDS and then adjuvant chemotherapy. At the end of 5 years, 24% patients were alive and 76% patients expired. The total recurrences in the study population was 86%. The mean overall survival at the end of 5 years was 15.2%. Absence of ascites post neo-adjuvant chemotherapy was a significant predictor of 5 year survival (p<0.0001). Type of resection, maximum tumor burden site and CA125 levels were also contributory prognostic factors in these patients.

Conclusion: The predictors of survival based on clinicopathological response to neoadjuvant chemotherapy after interval debulking surgery in advanced epithelial ovarian carcinoma include absence of ascites post NACT, R0 type of resection, maximum tumor burden at ovary or colon and post treatment mean CA125 levels of 33.97.