Suboptimal Surgery and Oncologic Outcomes in Women with Ovarian Cancer: An Analysis of Predictive Factors

Abstract Purposes: (1) To evaluate the response rate to primary treatment of patients with epithelial ovarian/tubal/primary peritoneal carcinoma and suboptimal surgery. (2) To identify the predicting factors for a response and survival. (3) To analyze the survival outcomes of patients. Methods: A retrospective cohort study was conducted of patients who underwent suboptimal surgery between May 2006 and December 2020. Data on clinical profiles, histopathology, tumor stages, surgical methods and outcomes, adjuvant treatment, and primary treatment outcomes were collected. Follow-up data were documented until March 31, 2023. Oncologic outcomes were analyzed. Results: Three hundred twenty patients were included. The overall response rate was 58.1%. The median progression free survival (PFS) was 13.2 months [Interquartile range (IQR) 6.7-20.6], and the median overall survival (OS) was 32.9 months [IQR, 15.0-53.6]. Two factors were significantly associated with no response: neoadjuvant chemotherapy (adjusted odd ratio (aOR) 3.342; 95% CI, 1.619-6.900, P =0.001), and high-grade serous carcinoma (HGSC; aOR 0.153, 95% CI 0.092-0.255, P <0.001). HGSC was significantly associated with a longer median PFS (15.9 vs 7.1 months, P <0.001) and a longer median OS (38.6 vs 16.6 months, P <0.001). Conclusions: The oncologic outcomes of the study patients were comparable to those of patients in landmark trials. HGSC has a higher response rate, longer PFS, and longer OS than non-HGSC.