Impact of neoadjuvant chemotherapy on fitness for surgery in high-risk patients with advanced ovarian cancer (566)

Objectives: Using a validated surgical triage algorithm, we identified women who are at high risk of postoperative morbidity & mortality (M/M) after surgery for advanced ovarian cancer (OC). We sought to determine the impact of neoadjuvant chemotherapy (NACT) on variables used to determine fitness for surgery and the resultant perioperative outcomes. Methods: Women who underwent primary (PDS) or interval (IDS) debulking surgery for stage IIIC/IV OC (institution 1: From January 2012 to July 2016; institution 2: From October 2011 to November 2019) were classified as high-risk or triage-appropriate retrospectively using a validated triage algorithm. A woman was considered high-risk if at least one of the following high-risk criteria were present: (i) Albumin <3.5g/dL, (ii) age ≥80 years, or (iii) age 75-79 and at least one of the following: ECOG (Eastern Cooperative Oncology Group) performance status >1, stage IV disease, or complex surgery required (more than hysterectomy, salpingo-oophorectomy, and omentectomy). For the NACT/IDS group, we compared serum albumin (normal: >3.5g/dL, low: <3.5g/dL) and triage risk classification before and after NACT, including only women who had data available at both time points. Outcomes were compared between groups using the Wilcoxon rank-sum test, Chi-square test, or Fisher’s exact test. Results: Among 959 included women, 65.3% (626/959) underwent PDS, and 34.7% (333/959) underwent NACT/IDS. Among 97 women in the NACT/IDS group who had low albumin before NACT, 90.7% (88/97) improved to normal, and a minority (9.3%, 9/97) remained low after NACT. A small proportion (2%, 3/148) of women who had normal albumin before NACT worsened to low albumin after NACT. Similarly, 66.1% (76/115) of women who were high-risk before NACT improved to triage-appropriate after NACT, and 33.9% (39/115) remained highrisk. A minority (2.2%, 3/136) of women who were triage-appropriate before NACT worsened to high-risk after NACT. When compared to the high-risk group who underwent PDS, the group who underwent NACT and improved to triage-appropriate before IDS had a significantly shorter median operative time, a lower proportion with high surgical complexity, a higher proportion with complete cytoreduction (no gross residual disease), and shorter median hospital stay (Table). The 90-day mortality for high-risk women who improved to triage-appropriate after NACT was five times lower than that of the high-risk group who underwent PDS (1.3% vs 6.5%; p=0.11), although this difference was not statistically significant due to low numbers. Conclusions: For women with advanced OC who are poor surgical candidates, NACT is an effective prehabilitation strategy for improving serum albumin levels, changing triage risk classification, and improving perioperative outcomes. Objectives: Using a validated surgical triage algorithm, we identified women who are at high risk of postoperative morbidity & mortality (M/M) after surgery for advanced ovarian cancer (OC). We sought to determine the impact of neoadjuvant chemotherapy (NACT) on variables used to determine fitness for surgery and the resultant perioperative outcomes. Methods: Women who underwent primary (PDS) or interval (IDS) debulking surgery for stage IIIC/IV OC (institution 1: From January 2012 to July 2016; institution 2: From October 2011 to November 2019) were classified as high-risk or triage-appropriate retrospectively using a validated triage algorithm. A woman was considered high-risk if at least one of the following high-risk criteria were present: (i) Albumin <3.5g/dL, (ii) age ≥80 years, or (iii) age 75-79 and at least one of the following: ECOG (Eastern Cooperative Oncology Group) performance status >1, stage IV disease, or complex surgery required (more than hysterectomy, salpingo-oophorectomy, and omentectomy). For the NACT/IDS group, we compared serum albumin (normal: >3.5g/dL, low: <3.5g/dL) and triage risk classification before and after NACT, including only women who had data available at both time points. Outcomes were compared between groups using the Wilcoxon rank-sum test, Chi-square test, or Fisher’s exact test. Results: Among 959 included women, 65.3% (626/959) underwent PDS, and 34.7% (333/959) underwent NACT/IDS. Among 97 women in the NACT/IDS group who had low albumin before NACT, 90.7% (88/97) improved to normal, and a minority (9.3%, 9/97) remained low after NACT. A small proportion (2%, 3/148) of women who had normal albumin before NACT worsened to low albumin after NACT. Similarly, 66.1% (76/115) of women who were high-risk before NACT improved to triage-appropriate after NACT, and 33.9% (39/115) remained highrisk. A minority (2.2%, 3/136) of women who were triage-appropriate before NACT worsened to high-risk after NACT. When compared to the high-risk group who underwent PDS, the group who underwent NACT and improved to triage-appropriate before IDS had a significantly shorter median operative time, a lower proportion with high surgical complexity, a higher proportion with complete cytoreduction (no gross residual disease), and shorter median hospital stay (Table). The 90-day mortality for high-risk women who improved to triage-appropriate after NACT was five times lower than that of the high-risk group who underwent PDS (1.3% vs 6.5%; p=0.11), although this difference was not statistically significant due to low numbers. Conclusions: For women with advanced OC who are poor surgical candidates, NACT is an effective prehabilitation strategy for improving serum albumin levels, changing triage risk classification, and improving perioperative outcomes.