Berczi Adrienne Szilvia, Lampé Olivér, Krasznai Zoárd Tibor, Orosz Mónika, Fábián Lili, Lampé Rudolf
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary.
Medicina (Kaunas). 2025 Aug 20;61(8):1493. doi: 10.3390/medicina61081493.
Advanced-stage epithelial ovarian cancer (EOC) is associated with poor prognosis, with complete macroscopic cytoreduction representing the strongest modifiable predictor of survival. Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative to primary debulking surgery (PDS) in patients with high tumor burden. However, its impact on surgical complexity remains debated. This study aimed to compare operative characteristics and survival outcomes between NACT + IDS and PDS using standardized scoring metrics in a real-world oncologic setting. We retrospectively analyzed 47 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV high-grade serous EOC treated between January 2018 and August 2022 at a single tertiary center. Twenty-five patients received platinum-taxane-based NACT followed by IDS, and twenty-two underwent upfront PDS with adjuvant chemotherapy. Surgical effort was quantified using the Surgical Complexity Score (SCS), and intra-abdominal tumor burden was assessed via the Peritoneal Cancer Index (PCI). Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Hazard ratios (HRs) with 95% confidence intervals were derived from Cox proportional hazards models. Complete cytoreduction (R0) was achieved in 76% of the NACT + IDS group and 68% of the PDS group. Mean surgical complexity and operative time were significantly lower following NACT (SCS 5.0 vs. 6.2, = 0.04; 140 vs. 197 min, = 0.001), without significant differences in blood loss, complication rates, or length of hospital stay. Median PFS was 25 months in the NACT + IDS group versus 21 months in the PDS group, and the difference was not statistically significant. Among patients with R0 resection, survival outcomes were comparable between treatment arms. NACT + IDS was associated with shorter and less complex surgeries in selected patients, but survival outcomes appeared similar when R0 was achieved. Data suggest that selective use of NACT in patients with extensive disease burden or limited general health status may be suitable, while confirming that complete cytoreduction remains the most critical prognostic factor, although these survival comparisons are exploratory given the retrospective design and limited sample size.
晚期上皮性卵巢癌（EOC）的预后较差，宏观上实现完全肿瘤细胞减灭是生存最强的可改变预测因素。对于肿瘤负荷高的患者，新辅助化疗（NACT）后行中间型肿瘤细胞减灭术（IDS）是原发性肿瘤细胞减灭术（PDS）的替代方案。然而，其对手术复杂性的影响仍存在争议。本研究旨在使用标准化评分指标，在真实世界的肿瘤学环境中比较NACT + IDS与PDS之间的手术特征和生存结果。我们回顾性分析了2018年1月至2022年8月在单一三级中心接受治疗的47例国际妇产科联盟（FIGO）IIIC-IV期高级别浆液性EOC患者。25例患者接受了以铂类-紫杉烷为基础的NACT，随后进行IDS，22例患者接受了 upfront PDS并辅助化疗。使用手术复杂性评分（SCS）对手术难度进行量化，并通过腹膜癌指数（PCI）评估腹内肿瘤负荷。使用Kaplan-Meier分析估计无进展生存期（PFS）和总生存期（OS）。95%置信区间的风险比（HRs）来自Cox比例风险模型。NACT + IDS组76%的患者和PDS组68%的患者实现了完全肿瘤细胞减灭（R0）。NACT后平均手术复杂性和手术时间显著降低（SCS 5.0对6.2，P = 0.04；140对197分钟，P = 0.001），失血、并发症发生率或住院时间无显著差异。NACT + IDS组的中位PFS为25个月，PDS组为21个月，差异无统计学意义。在R0切除的患者中，各治疗组的生存结果相当。NACT + IDS在选定患者中与更短、更简单的手术相关，但在实现R0时生存结果似乎相似。数据表明，对于疾病负担广泛或一般健康状况有限的患者，选择性使用NACT可能是合适的，同时证实完全肿瘤细胞减灭仍然是最关键的预后因素，尽管鉴于回顾性设计和样本量有限，这些生存比较是探索性的。
