Effects of neoadjuvant chemotherapy on prognosis and platinum resistance of advanced ovarian cancer

Objective: Primary Debulking Surgery (PDS) combined with platinum-based chemotherapy is the standard therapy for ovarian cancer. Some trials have suggested that neoadjuvant chemotherapy-Intermittent Debulking Surgery(NACT-IDS) can achieve equivalent efficacy in the chemotherapy of combining PDS, without influencing OS. This study aimed to explore the effects of NACT-IDS on the prognosis and platinum resistance of advanced ovarian cancer, so as to provide a certain basis for the selection of suitable clinical therapies. Methods: The patients with advanced ovarian cancer were selected from January 1, 2014 to January 1, 2017. The patients were assigned to NACT-IDS group or PDS group after evaluation by gynecological oncologists. We analysed the clinical data and collected the follow-up data of cases over 5 years. Results: Totally 173 patients were enrolled into the study, including 52 cases in NACT-IDS group and 121 cases in PDS group.The platinum-resistant relapse rate in NACT-IDS group was evidently greater than that in PDS group (22.9% vs 4.5%, P<0.001), and the multi-factor analysis results also proved that NACT (OR=7.822, 95%CI 2.121-28.855) was an independent risk factor for platinum-resistant relapse of ovarian cancer. No significant differences in PFS, RS and OS were found between two groups. Conclusion: NACT-IDS may increase the risk of platinum resistance, and it is not advisable to expand its indications blindly. During the IDS procedure, the surgical standard should aim for a more thorough tumor bed resection, achieving an R0 resection, in order to avoid the increased risk of recurrence. Precise selection of indications and comprehensive precision management throughout the treatment course are essential, as neoadjuvant chemotherapy does not necessarily affect prognosis.