Background: With an ongoing debate concerning the optimal timing of advanced ovarian cancer surgical treatment, primary debulking surgery (PDS) versus neoadjuvant chemotherapy followed by interval debulking surgery (IDS), this study aimed to compare survival outcomes between PDS and IDS populations and evaluate prognostic factors in a real-world cohort of patients treated with first-line chemotherapy and bevacizumab. Methods: A retrospective multi-center study was conducted involving 369 patients with newly diagnosed advanced ovarian cancer. Patient data included demographics, histology, treatment details, chemotherapy response, and survival outcomes. Kaplan–Meier estimates with log-rank tests were used for univariate analyses, as well as Cox proportional hazard models for multivariate analyses. Results: Patients undergoing IDS were older (62.5 vs. 60.0 years), had higher pretreatment CA-125 (1846 vs. 395.6 IU/mL), an increased proportion were at with stage IV (36.25% vs. 21.10%), and they received fewer bevacizumab cycles (12 vs. 18) compared to those undergoing PDS. Median progression-free survival (PFS) was 18.6 months (95% CI: 17.3–20.2) and overall survival (OS) was 45.4 months (95% CI: 41.1–52.1). Multivariate analysis confirmed poor chemotherapy response (HR 1.80, 95% CI: 1.36–2.37; p 70 (HR 1.62; p = 0.0202), poor response (HR 2.03; p < 0.0001), and IDS (HR 1.75; p = 0.0006). Conclusions: In this real-world cohort treated with first-line chemotherapy and bevacizumab, interval debulking surgery was associated with inferior progression-free and overall survival compared with primary debulking surgery. However, these findings reflect a high-risk population and are strongly influenced by patient selection and treatment pathways, underscoring the need for cautious interpretation.
Michalczyk et al. (Mon,) studied this question.
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