Meyer-Wilmes Philipp, Kennes Lieven Nils, Ignatov Atanas, Goetz Franziska, Wittenborn Julia, Stickeler Elmar, Tchaikovski Svetlana Nikolayevna
Department of Obstetrics and Gynecology, Center for Integrated Oncology (CIO Aachen, Bonn, Cologne, Düsseldorf), University Hospital of RWTH Aachen, Aachen, Germany.
Department of Economics and Business Administration, Stralsund University of Applied Sciences, Stralsund, Germany.
Arch Gynecol Obstet. 2025 Jul 11. doi: 10.1007/s00404-025-08095-3.
Tumor resection followed by adjuvant chemotherapy constitutes the cornerstone of ovarian cancer (OC) treatment. This study aimed to evaluate the impact of the time to chemotherapy (TTC) after primary surgery on the survival outcomes of patients with OC.
Patients with OC at any stage who underwent primary surgery followed by adjuvant chemotherapy between 2000 and 2021 were included in the analysis. Data were obtained from the Cancer Registries of Aachen and nine hospitals in Saxony-Anhalt. Patients were stratified into three subgroups based on the timing of chemotherapy initiation: early (≤ 21 days), intermediate (22-35 days) and late (> 35-180 days). The impact of TTC on progression-free survival (PFS) and overall survival (OS) was assessed using multivariate Cox proportional hazard models, both in complete case analysis and with multivariate imputation by chained equations to account for missing data.
A total of 1699 patients with OC (mean age: 61.4 ± 12 years) started adjuvant chemotherapy 32.2 ± 24.6 days after surgery. For OS, the optimal TTC was identified at 26 days post-surgery. Compared with the intermediate group, both earlier and later initiation of chemotherapy were associated with worsened OS (Hazard Ratio (HR) = 1.34, 95%CI 1.23-1.60, p < 0.05 and HR = 1.38 95%CI 1.14 -1.68; p < 0.001, respectively).
The optimal timing for initiating adjuvant chemotherapy appears to be between 22 and 35 days after primary surgery for ovarian cancer. Remarkably, an earlier start of chemotherapy did not confer a survival advantage, possibly due to the need for adequate recovery after surgery.
肿瘤切除术后辅助化疗是卵巢癌（OC）治疗的基石。本研究旨在评估初次手术后化疗时间（TTC）对OC患者生存结局的影响。
纳入2000年至2021年间接受初次手术及辅助化疗的各期OC患者进行分析。数据来自亚琛癌症登记处和萨克森-安哈尔特州的九家医院。根据化疗开始时间将患者分为三个亚组：早期（≤21天）、中期（22 - 35天）和晚期（>35 - 180天）。在完整病例分析以及使用链式方程进行多变量插补以处理缺失数据的情况下，使用多变量Cox比例风险模型评估TTC对无进展生存期（PFS）和总生存期（OS）的影响。
共有1699例OC患者（平均年龄：61.4±12岁）在术后32.2±24.6天开始辅助化疗。对于OS，确定术后26天为最佳TTC。与中期组相比，化疗开始时间过早或过晚均与OS恶化相关（风险比（HR）=1.34，95%置信区间1.23 - 1.60，p<0.05；HR = 1.38，95%置信区间1.14 - 1.68；p<0.001）。
卵巢癌初次手术后辅助化疗的最佳时机似乎在术后22至35天之间。值得注意的是，化疗开始时间过早并未带来生存优势，这可能是由于术后需要充分恢复。
