Is time to chemotherapy a determinant of prognosis in advanced-stage ovarian cancer?

Objectives: Clinicians often question when to start chemotherapy after patients undergo surgery for ovarian cancer. A major unproven concern is whether a long postoperative delay reduces the benefits of an extensive procedure and leads to disease progression. Our objectives were to evaluate the correlation between clinical and pathologic variables and to evaluate the effect of the "time to chemotherapy" (TTC) interval on survival. Methods: We retrospectively studied data from 218 patients with International Federation of Gynecology and Obstetrics stage IIIC or IV ovarian cancer (TNM stage T3c or T4) who were consecutively treated between January 1, 1994, and December 31, 1998. Results: Mean age at diagnosis was 64 years (range, 24-87 years; median, 65 years), and 206 patients received postoperative platinum-based chemotherapy. Mean TTC interval was 26 days (range, 7-79 days; median, 25 days). No correlation was found between operative time and TTC interval length (P = 0.99). Age and performance of rectosigmoidectomy were correlated with longer TTC interval (P = 0.009 and P = 0.005, respectively), but TTC was not a predictor of overall survival (odds ratio, 1.00; 95% confidence interval, 0.98-1.01; P = 0.85). Differences in TTC interval length (≤ 17 days, 18-26 days, 27-33 days, or ≥ 34 days) did not affect survival (P = 0.93). Even after categorizing patients by residual disease (<1 cm or  ≥ 1 cm), no statistically significant effect of TTC on prognosis was identified. Conclusions: Concerns about the TTC interval should not be used to justify spending less time in the operative arena or using a more conservative approach for patients with advanced ovarian cancer.