ArticleFrontiers in oncology2026
Time to adjuvant chemotherapy after cytoreductive surgery and survival outcomes in epithelial ovarian cancer: a retrospective cohort study.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.
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Corrections and comments
- Erratum issued
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13 authors.
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Abstract
Objectives: To evaluate the impact of the interval between maximal-effort cytoreductive surgery and initiation of adjuvant chemotherapy on progression-free survival (PFS) and overall survival (OS) in women with advanced epithelial ovarian cancer. Design and methods: A retrospective cohort study was conducted including 145 patients who underwent primary or interval cytoreductive surgery followed by adjuvant chemotherapy at a tertiary gynaecological oncology centre between 2016 and 2021. Time to chemotherapy (TTC) was categorised as ≤6 versus >6 weeks and ≤8 versus >8 weeks. Survival outcomes were assessed using Kaplan-Meier analysis and multivariable Cox proportional hazards regression. Results: The median age was 60 years, and most patients had FIGO stage IIIC disease (77.2%) and high-grade serous carcinoma (78.0%). Twenty-three patients (15.9%) underwent primary debulking surgery and 122 (84.1%) underwent interval debulking surgery. Complete gross resection (R0) was independently associated with improved overall survival (HR 2.92, 95% CI 1.66-5.14; p<0.001) and progression-free survival (HR 2.16, 95% CI 1.33-3.52; p=0.002). Initiation of adjuvant chemotherapy more than eight weeks after surgery was independently associated with shorter progression-free survival (HR 1.65, 95% CI 1.12-2.45; p=0.013) but was not associated with overall survival. Baseline CA125 >1000 U/mL independently predicted poorer progression-free survival (HR 1.68, 95% CI 1.11-2.56; p=0.016). Mutation status and surgical approach (primary versus interval debulking surgery) were not independently associated with survival following multivariable adjustment. Conclusions: Delayed initiation of adjuvant chemotherapy beyond eight weeks following maximal-effort cytoreductive surgery was independently associated with poorer progression-free survival but not overall survival. Complete gross resection remained the strongest prognostic factor for both survival outcomes. These findings support optimisation of postoperative treatment pathways to minimise avoidable delays in chemotherapy while maintaining safe postoperative recovery. Prospective multicentre studies are warranted to validate these findings.
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