PROGNOSIS FACTORS OF IMMEDIATE AND LONG-TERM OUTCOMES OF COMPREHENSIVE TREATMENT FOR PATIENTS WITH STAGE III–IV OVARIAN CANCER
DOI:
https://doi.org/10.15407/oncology.2026.02.127Keywords:
ovarian cancer, risk factors, radiation diagnostics, peritoneal carcinomatosis index, neoadjuvant polychemotherapy, cytoreductive surgery, overall survival, relapse-free survivalAbstract
Summary. Aim: to assess overall and progression-free survival in patients with stage III–IV ovarian cancer and to identify key factors influencing short- and long-term treatment outcomes in this cohort. Object and methods: single-center retrospective cohort study of 247 patients with stage III–IV ovarian cancer treated at Public Non-Commercial Enterprise "Prycarpathian Clinical Oncology Center Of The Ivano-Frankiv Regional Council" in 2017–2023. Four treatment groups were defined: I-II – primary cytoreductive surgery followed by 6 adjuvant cycles of combination chemotherapy (groups I and II differed by baseline peritoneal cancer index [PCI]); III – 3 neoadjuvant chemotherapy cycles, interval cytoreduction, then adjuvant chemotherapy; IV – 6 cycles of chemotherapy. All patients received paclitaxel plus carboplatin in a 21‑day regimen. Primary endpoints were overall survival and progression‑free survival, with response assessed per RECIST 1.1; platinum sensitivity was classified as refractory, resistant, or sensitive using standard time thresholds. Results: among 247 stage III-IV patients, 51 were non-platinum-sensitive: platinum-refractory relapses in 16 (5.5%) and platinum-resistant in 35 (14.2%), predominantly with intra-abdominal onset. Three-year overall survival: group III – 41%, group II – 39%, group IV – 18%. Three-year progression-free survival: group II – 21%, group III – 20%, group IV – 6%. Negative prognostic factors included baseline PCI, extent of cytoreduction (R0/R1/R2), and platinum sensitivity, p<0.05 (by odds-ratio analysis). Conclusions: it is recommended that all patients with stage III-IV ovarian cancer undergo computed tomography with determination of the peritoneal cancer index (PCI), with the initial therapeutic approach (surgery vs. neoadjuvant chemotherapy) decided according to PCI level. Administration of three NACT cycles reduces PCI by 1.29-fold, shortens the duration of cytoreduction without loss of radicality and without increasing intra-/postoperative complications, achieves partial response or disease stabilization in 92.4% of cases per RECIST 1.1 without deterioration in quality of life, and enables identification of platinum-refractory patients.
References
Reid BM, Permuth JB, Sellers TA. Epidemiology of ovarian cancer: a review. Cancer Biol Med 2017; 14 (1): 9–32. doi: 10.20892/j.issn.2095-3941.2016.0084.
Estimates of cancer incidence and mortality in 2020, for all cancer sites. European Cancer Information System. https://ecis.jrc.ec.europa.eu/index.php.
European Institute of Women's Health. Ovarian cancer: a silent killer. Eurohealth. https://eurohealth.ie/policy‐brief‐women‐and‐ovarian‐cancer‐in‐the‐eu‐2018/.
Colombo N, Sessa C, du Bois A, et al. ESMO‐ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease. Ann Oncol 2019; 30 (5): 672–705. doi: 10.1093/annonc/mdz062.
Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386 (9990): 249–57.
doi: 10.1016/S0140-6736(14)62223-6.
Vergote I, Trope CG, Amant F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med 2010; 363 (10): 943–53.
doi: 10.1056/NEJMoa0908806.
Onda T, Satoh T, Saito T, et al. Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. Eur J Cancer 2016; 64: 22–31. doi: 10.1016/j.ejca.2016.05.017.
Fagotti A, Ferrandina G, Vizzielli G, et al. Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome. Eur J Cancer 2016; 59: 22–33. doi: 10.1016/j.ejca.2016.01.017.
Liu EL, Mi RR, Wang DH, et al. Application of combined intraperitoneal and intravenous neoadjuvant chemotherapy in senile patients with advanced ovarian cancer and massive ascites. Eur J Gynaecol Oncol 2017; 38 (2): 209–13. Available at: https://www.ncbi.nlm.nih.gov/pubmed/29953782.
van Meurs HS, Tajik P, Hof MH, et al. Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial. Eur J Cancer 2013; 49 (15): 3191–201. doi: 10.1016/j.ejca.2013.06.013.
Tajik P, van de Vrie R, Zafarmand MH, et al. The FIGO Stage IVA Versus IVB of Ovarian Cancer: Prognostic Value and Predictive Value for Neoadjuvant Chemotherapy. Int J Gynecol Cancer 2018; 28 (3): 453–8. doi: 10.1097/IGC.0000000000001186.
Vergote I, Coens C, Nankivell M, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials. Lancet Oncol 2018; 19 (12): 1680–7. doi: 10.1016/S1470-2045(18)30566-7.
