Postoperative nausea and vomiting as a predictor of chemotherapy-induced nausea and vomiting in gynecologic cancer: a retrospective cohort study.

purposePostoperative nausea and vomiting (PONV) and chemotherapy-induced nausea and vomiting (CINV) share multiple patient-related risk factors, suggesting a common underlying emetogenic susceptibility. However, whether PONV serves as a clinically meaningful predictor of subsequent CINV remains unclear. This study aimed to determine whether the presence of PONV after gynecologic cancer surgery is associated with poorer CINV control during the first cycle of postoperative paclitaxel plus carboplatin chemotherapy.

methodsWe conducted a single-center retrospective cohort study in women with gynecologic malignancies who received postoperative paclitaxel plus carboplatin chemotherapy with guideline-consistent triplet antiemetic prophylaxis. PONV was evaluated during the 120-h postoperative period and was defined by the occurrence of vomiting or the need for rescue antiemetics. CINV outcomes, including complete response (CR; no emesis and no rescue medication), complete control (CC), total control (TC), nausea, significant nausea (CTCAE grade ≥ 2), and vomiting, were assessed across acute, delayed, extended delayed, overall, and extended overall periods. Logistic regression was performed to evaluate associations between PONV and CINV while adjusting for age and the use of olanzapine.

resultsAmong 161 eligible patients, 73 (45.3%) experienced PONV and 88 (54.7%) did not. The CR rate during the overall period (0-120 h) was significantly lower in patients with PONV than in those without PONV (73% vs 91%, p = 0.002). PONV-positive patients also had lower rates of CR, CC, and TC not only during the delayed and extended delayed phases but also across the overall and extended overall periods, and showed higher incidences of nausea and significant nausea, whereas vomiting outcomes showed minimal differences. Multivariable analysis demonstrated that PONV was independently associated with failure to achieve CR (adjusted OR 4.28, 95% CI 1.70-11.8, p = 0.003). No notable differences in adverse events were observed between groups.

conclusionPONV was a significant and independent predictor of poorer CINV control despite guideline-based triplet prophylaxis, and this association remained significant after adjusting for younger age and olanzapine use. These findings suggest that PONV reflects a distinct dimension of emetogenic vulnerability and may serve as a practical clinical marker to identify patients who could benefit from risk-adapted antiemetic strategies. Prospective studies are warranted to validate these findings and evaluate tailored prophylaxis approaches for high-risk patients.