Investigation About The Effect Of NACT On Platinum Resistance And Prognosis Of Patients With Epithelial Ovarian Cancer In The Real World Based On Propensity Score Matching

Objective:This study intends to analyze the retrospective case of medical records;to explore the effect of neoadjuvant chemotherapy on platinum resistance and prognosis of epithelial ovarian cancer patients in the real medical environment,providing guidance and basis for clinical treatment.Methods:From 2011 to 2016,207 patients with epithelial ovarian cancer who met the conditions of the study were selected in the Affiliated Cancer Hospital of Guangxi Medical University.According to the treatment method,the patients were divided into the neoadjuvant chemotherapy + surgery(NACT)group and the primary debulking surgery(PDS)group.Use propensity score matching to match patients’ baseline data at 2:1,and the matching factors included age,CCI score,family history of breast cancer or ovarian cancer,pathological type,histological grading,FIGO stage,preoperative CA125 level,intraperitoneal perfusion chemotherapy,and the total number of chemotherapy courses.The sensitivity of the NACT group and the PDS group to platinum drugs before and after matching was compared,and the relationship between baseline data and platinum drug resistance was analyzed by univariate and multivariate Logistic regression.Progression-free survival and overall survival of the patients were followed up.Univariate and multivariate survival analyses were conducted by using kaplan-meier analysis,log-rank test and Cox risk assessment model to explore the effect of the prognosis of the patients.Results:1.A total number of 125 patients in the NACT group and 82 patients in the PDS group were included,with the follow-up time of 44 months(a quartile distance of 27 to 62 months).Compared with the PDS group,NACT group of patients atⅣ period’s prevalence rate is higher(P=0.045),The ratio of CA125 to > at500U/ml was higher before treatment.the rate of abdominal cavity perfusion chemotherapy was more(P=0.000),the ratio of the total number of chemotherapy treatment is more than 6 range(P=0.000).And there was no significant statistics meanings in age,CCI score,family history of breast cancer or ovarian cancer,pathological type,histological grade between the two groups.2.Before the match,there was no significant difference in the chemotherapy response rate between the NACT group and the PDS group(93.6% vs 97.6%,P=0.321).After matching,the difference in chemotherapy response rate between the NACT group and the PDS group was not statistically significant(94.5% vs98.1%,P=0.401).3.In statistics,there was no significant difference in the recurrence rate between the NACT group and the PDS group before matching(74.4% vs 75.6%,P=0.844),The recurrence rate of platinum resistance in NACT group was significantly higher than that in PDS group,and multiple-factors analysis showed that NACT and the size of residual lesions were independent risk factors for platinum resistance.in statistics,there was no significant difference in recurrence rate between NACT group and PDS group after matching(74.0% vs76.9%,P=0.707);The recurrence rate of platinum resistance in the NACT group was still significantly higher than that in the PDS group(31.5% vs 15.4%,P=0.040).However,Multivariate analysis showed that the residual size and postoperative complications were independent risk factors for platinum resistance.4.The rate of no gross residual lesions(R0)in the NACT group before and after matching was significantly higher than that in the PDS group(P<0.05).In statistics,there was no significant difference in the rates of residual lesions<1cm(R1),epigastric surgery,intestinal surgery and postoperative complications between the two groups(P>0.05).5.the results of survival analysis showed that there was no significant difference in median PFS between the NACT group and the PDS group before and after matching(P>0.05).And there was no significant difference in median OS between NACT group and PDS group.The results of multivariate analysis showed that the matching of residual lesion size and postoperative complications were independent risk factors for PFS,Intraperitoneal perfusion chemotherapy,residual lesion size and postoperative complications were independent risk factors for OS,the size of postoperative residual focus and postoperative complications were independent risk factors for PFS.residual lesion size was an independent risk factor for OS.Conclusions;1.Propensity score matching can effectively eliminate the influence of confounders on the results of the retrospective study.2.Neoadjuvant chemotherapy increases the risk of platinum resistance in the first recurrence of advanced epithelial ovarian cancer,The size of residual focus and postoperative complications were independent risk factors for patients for platinum resistance.3.Neoadjuvant chemotherapy made it easier for surgery to reach R0 level,but it had no significant effect on progression-free survival and overall survival.4.The size of residual focus and postoperative complications were independent risk factors for patients for progression-free survival,The size of residual focus was an independent risk factor for patients for overall survival.