Primary Cytoreductive Surgery Versus Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: the Primary Cytoreductive Surgery is Better Than Neoadjuvant Chemotherapy in Platinum-resistant Patients

Purpose : We investigated the outcome of neoadjuvant chemotherapy (NACT) followed by interval cytoreductive surgery and primary cytoreductive surgery (PCS) in patients with platinum-sensitive or resistant advanced epithelial ovarian cancer. Materials and methods: The inclusion criteria fit 298 patients who underwent primary cytoreductive surgery (PCS group n=158) or neoadjuvant chemotherapy (NACT group n=140). Differences in characteristic features, chemotherapy responses, and prognosis were compared. Results: Although the median DFS was similar between the two groups, the median OS was significantly longer in the PCS (p=0.025). There was no survival advantage between the two groups regarding OS in platinum-sensitive patients. However, OS was significantly longer in platinum-resistant patients who underwent PCS (p=0.011). The rate of complete cytoreduction (R=0) was 47.5% in the PCS and 67.1% in the NACT group (p=0.001). Although DFS and OS advantages were observed in the PCS group in R=0 patients with a residual tumor, no significant difference was noticed between the two groups. The two groups had no OS advantage when platinum-sensitive patients were assessed for residual tumor. Meanwhile, in platinum-resistant patients, R=0 provided OS advantage in the PCS group (p=0.008). However, no significant difference was observed if there was any residual tumor (p=0.091). Conclusion: OS was significantly longer in the PCS group. Survival is better in platinum-resistant patients if no residual tumor exists after PCS. There was no difference in OS between the PCS and NACT groups in platinum-sensitive patients, regardless of residual tumor. Specific methods and markers are needed before initial treatment in epithelial ovarian cancer.