Iranian Red Crescent Medical Journal (IRCMJ)

Current Issue

By Issue

By Author

By Subject

Author Index

Keyword Index

About Journal

Aims and Scope

Editorial Board

Publication Ethics

Indexing and Abstracting

Related Links

FAQ

Peer Review Process

Journal Metrics

News

Author Guidelines

Article Processing Charge

Clinical Characteristics and 8-year Survival Rate in Advanced Ovarian Cancer Following Neoadjuvant Chemotherapy: A Single Center Experience

Document Type : Research articles

Authors

1 Gynecology Oncology Department, Vali-E-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: More than 75% of epithelial ovarian cancer (EOC) cases are diagnosed in advanced stages, which is associated with tumor recurrence and chemotherapy resistance. So far, to the best of our knowledge, a similar study has not been conducted in Iran to investigate the clinical characteristics and survival rate of these patients treated with neoadjuvant chemotherapy (NACT).
Objectives: This study aimed to evaluate the clinical characteristics and survival of patients treated with NACT followed by cytoreductive surgery and the factors affecting survival.
Methods: This retrospective cohort study was conducted on 147 advanced ovarian cancer cases who were treated with NACT referring to the Gynecology Oncology Department of Imam Khomeini Hospital in Tehran, Iran, between 2011 and 2021 and met the inclusion criteria for this study. The survival curve and Cox regression method were used to analyze the data.
Results: The results revealed that 8.9% of advanced EOC (147/1,650) were treated with NACT and the average number of NACT courses was 4.12 periods. The survival rates of 1, 3, 5, and 8 years were 85.31%, 44.05%, 18.35%, and 13.77%, respectively. The mean and median of survival time were 47.7 and 36 months, respectively. Nearly 80% of the patients had stages 3C and 4A before receiving NACT. Based on the results of the adjusted Cox regression model, tumor marker level showed a significant relationship with survival rate (P=0.008), and also peritoneum involvement had a clinically significant impact on survival with a hazard ratio of 2.88.
Conclusion: The results suggested that 8.9% of ovarian cancer cases were treated with NACT. It was also revealed that the average number of NACT courses was 4.12 periods and the 8-year survival rate was 13.77%. CA125 tumor marker level showed a significant relationship with survival rate, and peritoneum involvement had a clinically significant impact on survival.

Keywords

References
  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. doi: 10.3322/caac.21660. [PubMed: 33538338].
  2. WHO. Global health estimates 2020: deaths by cause, age, sex, by country and by region, 2000-2019. 2020. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death.
  3. Yi M, Li T, Niu M, Luo S, Chu Q, Wu K. Epidemiological trends of women's cancers from 1990 to 2019 at the global, regional, and national levels: a population-based study. Biomark Res. 2021;9(1):1-12.
  4. IARC. Ovary: Globocan 2020. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/25-Ovary-fact-sheet.pdf.
  5. Howlader N, Noone A, Krapcho M, Garshell J, Miller D, Altekruse S, et al. SEER cancer statistics review, 1975–2012. National Cancer Institute; 2014.
  6. Torre LA, Trabert B, DeSantis CE, Miller KD, Samimi G, Runowicz CD, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018;68(4):284-96. doi: 10.3322/caac.21456. [PubMed: 29809280].
  7. Wu SG, Wang J, Sun JY, He ZY, Zhang WW, Zhou J. Real-world impact of survival by period of diagnosis in epithelial ovarian cancer between 1990 and 2014. Front Oncol. 2019;9:1-10. doi: 10.3389/fonc.2019.00639. [PubMed: 31448220].
  8. Sato S, Itamochi H. Neoadjuvant chemotherapy in advanced ovarian cancer: latest results and place in therapy. Ther Adv Med Oncol. 2014;6(6):293-304. doi: 10.1177/1758834014544891. [PubMed: 25364394].
  9. Gao Y, Li Y, Zhang C, Han J, Liang H, Zhang K, et al. Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study. J Ovarian Res. 2019;12(1):1-8. doi: 10.1186/s13048-019-0562-9. [PubMed: 31519183].
  10. Batra S, Nayak H, Dave KS. Role of neoadjuvant chemotherapy (NACT) followed by surgical cytoreduction in advanced epithelial ovarian cancer. J Obstet Gynaecol India. 2012;62(5):541-5. doi: 10.1007/s13224-011-0106-8. [PubMed: 24082555].
  11. Mazzeo F, Berlière M, Kerger J, Squifflet J, Duck L, D’Hondt V, et al. Neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy in patients with primarily unresectable, advanced-stage ovarian cancer. Gynecol Oncol. 2003;90(1):163-9. doi: 10.1016/s0090-8258(03)00249-x. [PubMed: 12821358].
  12. Bijelic L, Jonson A, Sugarbaker P. Systematic review of cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy for treatment of peritoneal carcinomatosis in primary and recurrent ovarian cancer. Ann Oncol. 2007;18(12):1943-50. doi: 10.1093/annonc/mdm137. [PubMed: 17496308].
  13. Rose PG, Nerenstone S, Brady MF, Clarke-Pearson D, Olt G, Rubin SC, et al. Secondary surgical cytoreduction for advanced ovarian carcinoma. N Engl J Med. 2004;351(24):2489-97. doi: 10.1056/NEJMoa041125. [PubMed: 15590951].
  14. van der Burg ME, van Lent M, Buyse M, Kobierska A, Colombo N, Favalli G, et al. The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. N Engl J Med. 1995;332(10):629-34. doi: 10.1056/NEJM199503093321002. [PubMed: 7845426].
  15. Vergote I, Trope 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. doi: 10.1056/NEJMoa0908806. [PubMed: 20818904].
  16. 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. J Clin Oncol. 2016;34(28):3460-73. doi: 10.1200/JCO.2016.68.6907. [PubMed: 27502591].
  17. 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. doi: 10.1016/S0140-6736(14)62223-6. [PubMed: 26002111].
  18. Picot J, Cooper K, Bryant J, Clegg A. The clinical effectiveness and cost-effectiveness of bortezomib and thalidomide in combination regimens with an alkylating agent and a corticosteroid for the first-line treatment of multiple myeloma: a systematic review and economic evaluation. Health Technol Assess. 2011;15(41):1-204. doi: 10.3310/hta15410. [PubMed: 22146234].
  19. Berek JS. Berek & Novak's gynecology. Lippincott Williams & Wilkins; 2019.
  20. Matsuo K, Matsuzaki S, Nusbaum DJ, Maoz A, Oda K, Klar M, et al. Possible candidate population for neoadjuvant chemotherapy in women with advanced ovarian cancer. Gynecol Oncol. 2021;160(1):32-9. doi: 10.1016/j.ygyno.2020.10.027. [PubMed: 33196436].
  21. Moschetta M, Boussios S, Rassy E, Samartzis EP, Funingana G, Uccello M. Neoadjuvant treatment for newly diagnosed advanced ovarian cancer: where do we stand and where are we going? Ann Transl Med. 2020;8(24):1-9. doi: 10.21037/atm-20-1683. [PubMed: 33490222].
  22. Melamed A, Hinchcliff EM, Clemmer JT, Bregar AJ, Uppal S, Bostock I, et al. Trends in the use of neoadjuvant chemotherapy for advanced ovarian cancer in the United States. Gynecol Oncol. 2016;143(2):236-40. doi: 10.1016/j.ygyno.2016.09.002. [PubMed: 27612977].
  23. Knisely AT, Clair CMS, Hou JY, Collado FK, Hershman DL, Wright JD, et al. Trends in primary treatment and median survival among women with advanced-stage epithelial ovarian cancer in the US from 2004 to 2016. JAMA Netw Open. 2020;3(9):e2017517-e.
  24. Nakamura K, Kitahara Y, Nishimura T, Yamashita S, Kigure K, Ito I, et al. Nadir CA-125 serum levels during neoadjuvant chemotherapy and no residual tumor at interval debulking surgery predict prognosis in advanced stage ovarian cancer. World J Surg Oncol. 2020;18(1):1-9. doi: 10.1186/s12957-020-01978-6. [PubMed: 32791996].
  25. 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. doi: 10.1136/ijgc-2020-001641. [PubMed: 33106271].
  26. Jayde V, White K, Blomfield P. Symptoms and diagnostic delay in ovarian cancer: a summary of the literature. Contemp Nurse. 2010;34(1):55-65. doi: 10.5172/conu.2009.34.1.055. [PubMed: 20230172].
  27. 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. doi: 10.1136/ijgc-2020-001640. [PubMed: 33028623].
  28. Rauh-Hain JA, Melamed A, Wright A, Gockley A, Clemmer JT, Schorge JO, et al. Overall survival following neoadjuvant chemotherapy vs primary cytoreductive surgery in
  29. women with epithelial ovarian cancer: analysis of the National Cancer Database. JAMA Oncol. 2017;3(1):76-82. doi: 10.1001/jamaoncol.2016.4411. [PubMed: 27892998].
  30. Feng Z, Wen H, Li R, Liu S, Fu Y, Chen X, et al. Comparison of survival between primary debulking surgery versus neoadjuvant chemotherapy for ovarian cancers in a personalized treatment cohort. Front Oncol. 2021;10:1-6. doi: 10.3389/fonc.2020.632195. [PubMed: 33643924].
  31. Fleming ND, Westin SN, Rauh-Hain JA, Soliman PT, Fellman BM, Coleman RL, et al. Factors associated with
  32. response to neoadjuvant chemotherapy in advanced stage ovarian cancer. Gynecol Oncol. 2021;162(1):65-71. doi: 10.1016/j.ygyno.2021.04.002. [PubMed: 33838925].
  33. Liu YL, Filippova OT, Zhou Q, Iasonos A, Chi DS, Zivanovic O, et al. Characteristics and survival of ovarian cancer patients treated with neoadjuvant chemotherapy but not undergoing interval debulking surgery. J Gynecol Oncol. 2020;31(1):1-12. doi: 10.3802/jgo.2020.31.e17. [PubMed: 31833259].
  34. Zeng J, Huang H, Shan Y, Li Y, Jin Y, Pan L. The effect of CA125 nadir level on survival of advanced-stage epithelial ovarian carcinoma after interval debulking surgery. J Cancer. 2017;8(17):3410-15. doi: 10.7150/jca.21362. [PubMed: 29151924].
  35. Zwakman N, van de Laar R, van Gorp T, Zusterzeel PL, Snijders MP, Ferreira I, et al. Perioperative changes in serum CA125 levels: a prognostic factor for disease-specific survival in patients with ovarian cancer. J Gynecol Oncol. 2017;28(1):1-12. doi: 10.3802/jgo.2017.28.e7. [PubMed: 27670261].
Iranian Red Crescent Medical Journal (IRCMJ)
Volume 24, Issue 10 - Serial Number 10
2022
Files
History
  • Receive Date: 14 May 2022
  • Revise Date: 19 May 2024
  • Accept Date: 27 January 2024
  • First Publish Date: 27 January 2024
  • Publish Date: 01 October 2022
Share
How to cite
Statistics