Fig. 4.

Overall and progression-free survival of patients treated with neoadjuvant chemotherapy and interval cytoreductive surgery (NAC) or primary cytoreductive surgery and adjuvant chemotherapy (PCS) stratified by surgical cytoreduction status. (A) Optimal surgical cytoreduction to less than 1 cm residual tumour had no significant impact on overall survival in the neoadjuvant group. In addition, within the suboptimally debulked group, neoadjuvant chemotherapy had no significant effect. However, within the optimal subgroup, the neoadjuvant patients had a worse overall outcome (p < 0.001). Within the adjuvant group, patients who were optimally debulked had a significantly improved survival (p = 0.001). (B) Optimal surgical cytoredcution resulted in better progression-free survival in patients treated with neoadjuvant chemotherapy or primary surgical cytoreduction (p = 0.020 and p = 0.002, respectively). However, in the optimally and suboptimally surgically debulked groups, the patients who received neoadjuvant chemotherapy had a significantly worse progression-free survival (p < 0.001 for both comparisons). All statistics were calculated with a log-rank (Mantel–Cox) test. Bonferroni corrections were applied for all multiple comparisons. N/S = nonsignificant.