Aim: To examine the prognostic impact of textbook oncologic outcome (TOO) in patients with advanced ovarian cancer undergoing primary chemotherapy, along with identifying the risk factors for TOO failure.
Methods: Patients who underwent neoadjuvant chemotherapy followed by interval debulking surgery for advanced ovarian cancer at a tertiary center between 2014 and 2019 were retrospectively reviewed. TOO was defined as complete cytoreduction, no severe complications, no prolonged hospital stay, no readmission, no delayed initiation of adjuvant chemotherapy, and no 90-day mortality. The associations between TOO and clinical characteristics (survival) were examined using logistic and Cox regression analyses.
Results: Among 165 patients, 65 (39.4%) achieved TOO. The most common reason for TOO failure was incomplete cytoreduction (n = 46, 27.9%). Older age (p = 0.049) and visceral obesity (p = 0.030) were independently associated with TOO failure. Patients who achieved TOO had significantly prolonged overall survival (OS; median: 52 vs. 31 months, p = 0.010) and progression-free survival (PFS; median: not reached vs. 19 months, p = 0.006) compared to those who did not achieve TOO. Multivariate analysis revealed that TOO achievement was an independent protective factor for OS (hazard ratio [HR] 0.591, 95% confidence interval [CI] 0.387-0.905, p = 0.015) and PFS (HR 0.626, 95% CI 0.410-0.956, p = 0.030).
Conclusions: TOO is an effective predictor of favorable outcomes in patients with advanced ovarian cancer undergoing interval debulking surgery. Factors such as older age and visceral obesity may hinder the achievement of TOO.
Keywords: interval debulking surgery; ovarian cancer; prognosis; textbook oncologic outcome.
© 2025 Japan Society of Obstetrics and Gynecology.