| Objective:1) To compare the survival and perioperative morbidity between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NAC/IDS) in treating patients with advanced epithelial ovarian cancer (EOC), To discussing the NACT-IDS in the clinical application value.2) To study the clinical characteristics of ovarian epithelial cancer and to investigate the influence of age, clinical stage,pathological type, residual tumor size and course of chemotherapy on the prognosis of epithelial ovarian cancer.Materials and Methods:Part one:Retrospective analysis of101patients with advanced epithelial ovarian cancer (FIGO Ⅲ-Ⅳ) of our hospital during Jan.2005and Dec.2011were performed. Of these patients,59cases were treated with neoadjuvant chemotherapy and interval debulking surgery (observation group), while other42cases were underwent primary cytoreductive surgery and chemotherapy (control group). Optimal cytoreduction rate, Side effects, Disease-free survival and Overall survival were analyzed.Part two:Retrospective analysis the clinical data of168patients with epithelial ovarian cancer. Including patients age at diagnosis, clinical stage, pathological type,residual tumor size and course of chemotherapy. All patients were followed-up by telephone and survival outcomes were determined. All patients were staged according to the criteria set by the International Federation of Gynecology and Obstetrics (FIGO). Search of prognosis of ovarian cancer.Results:Part One:In101patients with advanced epithelial ovarian cancer patients,59cases treated with neoadjuvant chemotherapy intermediate cytoreductive surgery (NACT-IDS),42routine initial tumor cell cytoreductive surgery (PDS), NACT-IDS group average age of54years; clinical manifestations:abdominal distension or abdominal pain,25cases,12cases of irregular menstruation, physical examination found9cases,6cases of vaginal discharge, abdominal mass in7cases; pathological type was serous in33cases,14cases of mucinous, clear cell carcinoma in3cases,2cases of endometrial mixed in6cases, other types of cases; clinical stage:55cases of Phase Ⅲ of IV; histological grade:14cases of well-differentiated, moderately differentiated35cases,poorly differentiated in10cases. PDS mean age of49.5years, clinical manifestations:abdominal distension, abdominal pain12cases,9cases of irregular menstruation, physical examination was found in14cases,4cases of vaginal discharge, abdominal mass in three cases; pathological type was23cases of serous, mucinous sex,13cases of clear cell carcinoma in2cases,2cases of endometrial mixed cases, other types of cases; clinical stage:Phase Ⅲ41cases, Ⅳ,1case; histological grade:14cases of well-differentiated, moderately differentiated35cases,10cases of poorly differentiated. The two groups of age, clinical manifestations, histological type, histological grade were not statistically different (P>0.05).In NACT-IDS group,The optimal cytoreduction (residual disease<1cm) and non-optimal cytoreductive (residual disease≥1cm) were38cases (74.0%) and21 patients (26%), PDS group were23cases(54.7%) and19patients (45.3%). The difference between the two groups was statistically significant (P<001). In NACT-IDS group of7patients (11.8%) complications, including bowel obstruction in2cases,2cases of rectal perforation, wound exudate in1case, the suture of the incision Ⅱ2cases; the PDS group9cases (21.4%), including wound infection2cases,5cases of intestinal obstruction, fistula in2cases, The complication rate of the former than the latter, but the difference was not statistically significant (P>0.05). The PDS group intraoperative blood loss, the amount of ascites and operative time with the control differences were statistically significant (P<005), postoperative hospital stay compared the two groups no significant difference.In NACT-IDS group, the total effective rate (CR+PR) was72.8%(43/59), compared with38.0%(16/42) of the PDS group difference was statistically significant (P<0.05); cytoreductive surgeryimplementation of NACT-IDS group78.0%is much higher than45.0%of the PDS group, a statistically significant difference (P<0.05). Followed up for6-72months, the NACT-IDS group of the recurrence in6cases (10.2%),3patients died (5.1%), and the PDS group4cases of recurrence (9.5%),4patients died (9.5%), two sets of results statistically significant difference (P>0.05). Two sets of1-year survival rates were94.9%and92.8%, respectively (P>0.05),3-year survival rates were76.2%and59.5%, respectively (P>0.05), no statistically significant difference in the two sets of resuits.In NACT-IDS group, the average progression-free survival and overall survival time was22.7months (7-63.5) and33.5(13.8-92.3) months, the PDS group were21.7months (4.3-61.2) and32.1(12.4-114.9) months. Progression-free survival and overall survival of the two control groups was not statistically significant (P=0.082and P-0.293). The two groups of5-year survival17.8%and11.4%, the difference was not statistically significant (P=0.503).Part two:Analyzed by the Kaplan-Meier method and log-rank test, Our data showed that patients’ age at diagnosis, clinical stage, residual tumor size and course of chemotherapy were associated with the prognosis of epithelial ovarian cancer. There were no statistical difference among different pathological types on the prognosis of ovarian cancer. The average survival time of the younger group (<50years old) was58.27months, the overall survival rate was55.3%;while the average survival time of the older group (>50years old) was only50.01months, the overall survival rate was20.50%. The difference between the survival rate of these two groups were significant (P=0.036), which suggested that younger patients have better prognosis than the older ones. The average survival time of early, stages (I and II) was85.2months,the overall survival rate was69.5%; but the average survival time of advanced stages (Ⅲ-Ⅳ was only42.4months, the overall survival rate was29.10%. The difference between the survival rate of these two groups were significant (P<0.01). The average survival time of ideal tumor cytoreductive surgery group (residual tumor size<1cm) was71.2months, the overall survival rate was53.1%; but the average survival time of the unsuccessful cytoreductive surgery group (residual tumor diameter>1cm) was only27months, the overall survival rate was13.1%. The difference between the survival rate of these two groups was significant (P<0.05). The residual tumor size of primary surgery was an important prognostic factor for patients with epithelial ovarian cancer. The average survival time of patients with serous carcinoma was58.0months. The average survival time of patients with mucinous carcinoma was73.5months and95%confidence interval were [50.068,103.940]. The average survival time of patients with endometrioid carcinoma was71.1months. The average survival time of patients with clear-cell carcinomas was50.2months. There were no statistical difference among survival rate of different pathological types (P=0.238). The average survival time of the>6courses group was40.1months, the overall survival rate was54.4%; but the averagesurvival time of the<6courses group was only40.3months, the overall survival rate was20.2%. The difference between the survival rate of these two groups was significant (P=0.002), which suggested enough courses of chemotherapy can significantly prolong the survival time of epithelial ovarian cancer patients. The clinical stage, quality of surgery and course of chemotherapy were prognostic factors influencing survival in the final multivariate Cox proportional hazard model. The risk of death for patients with advanced stages was3.559times of the early-stage ones. The risk of death for patients with residual rumor size>1cm was2.590times of patients with residual tumor size<1cm. The risk of death for patients who undertook6courses of chemotherapy or more was0.374times of patients who undertook less than6courses. Univariate analysis younger patients was significantly better prognosis in elderly patients, but by multivariate regression analysis results have shown that age is not independent prognostic.Conclusions:1) NACT followed by surgical cytoreduction was a promising treatment strategy for the management of advanced epithelial ovarian cancers. Down staging following NACT leads to higher optimal cytoreduction rates and improved survival. but did not improve the patient’s disease-free survivalrate and overall survival.2) The clinical stage is an important factor in affecting the prognosis of epithelial ovarian cancer. The ideal tumor cytoreductive surgery in conjunction with6courses or more than6courses of chemotherapy can significantly improve the prognosis of epithelial ovarian cancer.pathological type have no influence on the prognosis of epithelial ovarian cancer. |
PDF Full Text Request