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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Tuesday, January 21, 2025
Alexandra Bercow, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues highlighted a significant shift in the treatment landscape for advanced epithelial ovarian cancer in the United States. Between 2010 and 2021, neoadjuvant chemotherapy followed by interval cytoreductive surgery became the dominant initial treatment modality. The findings, published in a research letter in JAMA Network Open, revealed a decline in the use of primary cytoreductive surgery use, particularly for stage IV advanced epithelial ovarian cancer, coupled with increased adoption of interval cytoreductive surgery across all age groups.
“While the trend was largely observed among those with stage IV disease, the use of neoadjuvant chemotherapy has increased significantly across all stages and ages,” stated the investigators. This shift, they noted, seems to align with evidence suggesting that neoadjuvant chemotherapy followed by interval cytoreductive surgery achieves comparable survival outcomes with reduced postoperative morbidity.
This retrospective cohort study analyzed data from 87,449 patients with stage III to IV advanced epithelial ovarian cancer in the National Cancer Database between 2010 and 2021. Patients were categorized into three treatment groups: primary cytoreductive surgery, neoadjuvant chemotherapy followed by interval cytoreductive surgery, or no surgery.
Over the study period, the use of primary cytoreductive surgery declined from 70.1% in 2010 to 37.2% in 2021 (rate ratio [RR] = 0.54; 95% confidence interval [CI] = 0.52–0.55), whereas the use of interval cytoreductive surgery increased from 16.6% to 40.8% (RR = 2.49; 95% CI = 2.36–2.61). Concurrently, the proportion of patients receiving no surgery rose modestly, from 13.3% to 22.0% (RR = 1.62; 95% CI = 1.52–1.73). The decline in primary cytoreductive surgery was observed across all age groups and stages of disease, with a more pronounced decrease in those with stage IV disease (RR = 0.42) compared with those who had stage III disease (RR = 0.65).
Disclosure: Dr. Bercow reported no conflicts of interest. For full disclosures of the other study authors, visit jamanetwork.com.
