A multidisciplinary agreement was used to determine whether or not patients diagnosed with advanced epithelial ovarian cancer (AEOC) between October 2018 and October 2020 should receive primary chemotherapy salvage (PCS) or neoadjuvant chemotherapy (NACT). Patient factors (PF), surgical resectability scores (SRS), and surgical complexity scores (SCS) were prospectively recorded with data on unresectable stage IVb. To forecast the success of optimal (RD<1 cm) cytoreduction, an integrated predictive model (IPM) was created. The effectiveness of the IPM was analyzed retroactively. The Youden Index was used to decide on the thresholds. About 81 patients were treated with PCS, and 104 were given NACT out of a total of 185. When comparing PCS patients to NACT patients, the median PF and SRS and pre-operative SRS were (0 vs. 2, P<0.01), SRS (2 vs. 4, P<0.01), and pre-operative SCS (6 vs. 8.5, P=0.01). Patients with PCS had an 88% success rate for cytoreduction, with 34.5% experiencing postoperative sequelae of grades 3-4. A model was developed with 85% sensitivity, 75% specificity, and 85% accuracy to determine which patients with unresectable Stage IVb disease (PF more than 2, SRS more than  5, and SCS more than 9) would benefit most from NACT. The researchers found that 3 out of 10 patients with sub-optimal cytoreduction may have been better triaged to NACT using this methodology. When the same cutoffs were applied to an outcome of no gross residual illness (RD=0 mm), the sensitivity and specificity were 85% and 76%, respectively. High sensitivity and specificity for optimum cytoreduction with acceptable morbidity and no delay to adjuvant therapy were found in the 4-step IPM algorithm. After additional validation, this method could decide whether to refer patients to PCS or NACT.

Source: sciencedirect.com/science/article/pii/S0090825822004309