Primary debulking surgery (PDS) or interval debulking surgery (IDS) and a platinum-based chemotherapy are the current standard approach for the treatment of advanced ovarian cancer (OC). Time to initiation of chemotherapy (TTC) could influence patient outcome.
In a multicenter retrospective cohort study of advanced (FIGO stage III or IV) OC, patients underwent a germline multi-gene panel evaluation between 2014-2018 TTC, calculated as the time from PDS or IDS to the start of chemotherapy, was assessed in relation to progression-free or overall survival (PFS, OS). Age, residual tumor (R: R0, R+), ascites (no, yes), bevacizumab use (no, yes), and mutational status (BRCAmut, other mut, wild-type - WT) were collected. Time-to-event endpoints were analyzed using the Cox model and results reported as hazard ratios (HRs) and 95% confidence intervals (CIs). All analyses were performed for PDS and IDS, separately.
Among the 137 eligible patients, the median TTC was 45 days (1st–3rd quartile: 38; 58 days) and 21.9% of patients with a TTC≥60 days. BRCAmut patients were 18.3%, 10.2% with germline mutation in other DNA repair genes and 71.5% were WT. Median follow-up time was 67.9 months (95% CI: 56.6–87.8). TTC was significantly associated with R only in PDS patients (n=83): 16.9% with TTC<60 and 64.3% with TTC≥60 days, p<0.001. At univariate analysis, TTC≥60 days was associated with a shorter PFS in PDS patients (HR 2.02, 95% CI: 1.04-3.93, p=0.038), although this association lost statistical significance when adjusted for R (HR 1.52, 95% CI: 0.75-3.06, p=0.244 for TTC and HR 2.73, 95% CI: 1.50-4.96, p= 0.001 for R). In a stratified analysis by R, there appeared to be some evidence of an association between TTC and PFS among R+ patients, n=20, (HR 2.53, 95% CI: 0.86-7.47, p=0.093). Regarding OS, at univariate analysis TTC≥60 was associated with an adverse outcome even if not statistical significant (HR 2.03, 95% CI: 0.75-5.51, p=0.161). Among IDS patients we found no evidence of association between TTC and clinical outcomes.
A shorter TTC may affect patient prognosis in PDS patients, especially in case of R+, but larger casuistry is needed to confirm our hypothesis.