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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Friday, September 26, 2025
Higher utilization of neoadjuvant chemotherapy for advanced ovarian cancer was linked to lower 90-day surgical mortality across case volume tertiles, according to findings published in JAMA Network Open. Alexander Melamed, MD, MPH, of Massachusetts General Hospital, Boston, and colleagues conducted the cross-sectional study to assess whether neoadjuvant chemotherapy utilization and hospital volume may be associated with postoperative mortality and overall survival after cytoreductive surgery in patients with advanced-stage ovarian cancer.
“However, the lowest 90-day surgical mortality and the longest 60-month survival for patients with advanced-stage ovarian cancer was found in high-volume centers with high utilization of neoadjuvant chemotherapy,” the authors added.
The investigators focused on 70,707 patients treated for newly diagnosed stage III or IV epithelial ovarian cancer at 1,333 Commission on Cancer–accredited cancer programs in the United States between January 2010 and December 2019. The median age of the population was 63.1 years, with 79.7%, 8.2%, and 6.7% identifying as White, Black, and Hispanic, respectively.
After adjusting for observed demographic and clinical covariates, the investigators reported lower 90-day surgical mortality in centers with higher neoadjuvant chemotherapy rates, with the magnitude of this association differing by hospital volume (P for interaction < .001). High (59%) vs low (22%) utilization of neoadjuvant chemotherapy was found to be associated with a larger decrease in 90-day mortality in high- (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.17–0.41; 10.0% vs 2.9%) vs average- (OR = 0.49, 95% CI = 0.33–0.72; 7.3% vs 3.7%) and low- (OR = 0.48, 95% CI = 0.39–0.60; 9.5% vs 4.8%) volume centers. In high-volume centers, high vs low neoadjuvant chemotherapy utilization seemed to be associated with a 4.0-month (95% CI = 1.6–6.5 months) improvement in 60-month life expectancy (42.2 vs 38.1 months).
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
