Response Evaluation Of Neoadjuvant Chemotherapy And Interal Cytoreductive Surgery Or Primary Cytoreductive Surgery In Advanced Stage Ovarian Cancer

Objective To evaluate the therapeutic benefit of neoadjuvant chemotherapy and interal cytoreductive surgery or primary cytoreductive surgery in advanced ovarian cancer patients.Methods We retrospectively investigated 184 patients with advanced ovarian cancer in Tianjin Medical University General Hospital.127 patients underwent PCS and postoperative adjuvant chemotherapy(PCS group),and 57 patients received NACT combined with interal cytoreductive surgery(NACT group).The clinicopathological features,laboratory findings,surgical status,postoperative complications,progression-free survival(PFS),and overall survival(OS)were compared between the two groups.Results 1.Compared with the PCS group,the NACT group had a lower KPS score(p=0.000)and a higher CCI(p=0.000).Gastrointestinal symptoms such as abdominal distention(p=0.000),nausea and vomiting(p=0.000)were more common in the NACT patients.The incidence of pleural effusion(p=0.000)and ascites(p=0.005)was also higher in the NACT group.Besides,patients in the NACT group had larger primary tumor diameters(p=0.026).2.The HB(p=0.020)and ALB(p=0.000)in the NACT group were lower than those in the PCS group,and the WBC(p=0.005)and PLT(p=0.000)was higher than the PCS group.CA125(p=0.000),CA199(p=0.001),and HE4(p=0.005)levels were significantly higher in the NACT group than in the PCS group.3.The diameter of the maximal metastatic foci before treatment was larger(p=0.000),and the incidence of peritoneal infiltration(p=0.000),omental cake(p=0.000)and stomach or bowel infiltration(p=0.042)was higher in the NACT group.CT results suggest that patients with the maximal metastatic foci>4.5cm,mesenteral retraction,stomach or bowel infiltration,or omental cake have a lower satisfactory tumor reduction rate.There was no significant difference in the incidence of upper abdominal surgery(p=0.081)and bowel resection(p=0.980)in the two groups.The transfusion probability in the NACT group was higher than that in the PCS group(p=0.000).Patients in the NACT group had a shorter operative time(p=0.0031,a higher satisfactory tumor reduction rate to R0(p=0.000).4.There were no obvious differences in postoperative cardiovascular complications(p=0.929),wound infection(p=0.054),pneumonia(p=0.176),bacteremia(p=0.176),urinary tract infection(p=0.341),venous thrombosis(p=0.590),intestinal obstruction(p=0.406),and vaginal rectal fistula(p=0.341)between the two groups.The time from surgery to adjuvant chemotherapy(p=0.053)and total hospital stay(p=0.995)were shorter in the NACT group,but the difference was not statistically significant.No significant differences were observed in chemotherapy resistance(p=0.208),tumor uncontrolled/recurrence(p=0.421),and mortality rate(p=0.631).5.Kaplan-Meier survival curve analysis indicated no significant difference in PFS(p=0.051)and OS(p=0.100)between the two groups.In the Cox regression model,patients have ascites,residual tumor volume>0cm/ ≥ 1cm and chemotherapy resistance were independent risk factors for the prognosis of advanced ovarian cancer patients.Conclusion 1.Compared with the PCS group,the NACT group may have more severe clinical symptoms,worse physical condition and more complications.2.The diameter of the primary tumor and maximal metastatic foci in the NACT group is larger than the PCS group.The incidence of peritoneal infiltration,omental cake,stomach or bowel infiltration and ascites is higher,and the levels of CA125 and HE4 before treatment are higher in the NACT group.3.NACT may be considered for patients who are poor surgical candidates,or for patients with bulky disease who are deemed unlikely to be completely cytoreduced to R0.4.NACT shortens the operation time,increases the complete tumor resection and satisfactory tumor reduction rate,but does not change the surgical complexity,the incidence of postoperative complications and the time from surgery to adjuvant chemotherapy.5.Although NACT patients have a higher chance of tumor uncontrolled,tumor recurrence,and chemotherapy resistance,the difference is not statistically significant due to small sample size.6.Patients with ascites,residual tumor volume>0cm/≥1cm,chemotherapy resistance are independent risk factors affecting the prognosis of advanced ovarian cancer patients,but NACT does not improve the patient’s PFS and OS.