The Study Of The Therapeutic Of Secondary Cytoreduction Surgery In Patients With Platinum Sensitive Recurrent Ovarian Cancer With Unsatisfactory Primary Cytoreduction Surgery

Objective:To explore the effects of secondary cytoreductive surgery plus chemotherapy and chemotherapy alone on progression-free survival(PFS)and overall survival(OS)after treatment in patients with first recurrence of platinum-sensitive recurrent ovarian cancer with unsatisfactory primary cytoreduction surgery.Methods:A total of 116 patients with first recurrence of platinum-sensitive recurrent ovarian cancer underwent treatment in Shanxi Provincial Cancer Hospital from January 2005 to December 2018 were enrolled.All the patients failed to achieve complete cytoreductive at the primary surgery(residual lesions > 1cm).The condition of first recurrence of the patients was evaluated and surgical resection of the recurrent lesions was considered feasible.According to the treatment plan actually adopted after admission,33 patients were divided into the operation + chemotherapy group(postoperative residual lesions <1cm)and 83 patients were divided into the chemotherapy alone group.By propensity score matching,25 patients were selected from the two groups respectively to form a matching cohort to eliminate the impact of the differences in baseline characteristics between the two groups on the analysis results.Survival status and time of death of the patients at the end of the study were obtained through follow-up.PFS and OS after treatment for the first recurrence of the patients were calculated,and the effects of the two treatment regimens on PFS and OS after treatment were compared.Results:1.In the overall cohort,the 2-year progression-free survival rate was 7.76% for all116 patients,and the median follow-up time for all patients at the end of the study was 38 months,compared with 49 months in the surgery + chemotherapy group and 34 months in the chemotherapy alone group.2.In the overall cohort,the median progression-free survival and 2-year overall survival rate(excluding the survival patients who had been followed up for less than 2years at the end of the study)in the surgery + chemotherapy group were significantly higher than those in the chemotherapy alone group,11 months(range 4-50 months)vs 7months(range 3-53 months)and 93.9%(31/33 patients)vs 78.0%(64/82 patients),respectively(P<0.05).3.In the overall cohort,the survival curves of patients in the surgery +chemotherapy group and the chemotherapy alone group were analyzed,and the PFS and OS of patients in the surgery + chemotherapy group after treatment were significantly longer than those in the chemotherapy alone group(P<0.05).4.In the matched cohort,the 2-year survival rate of patients in the surgery +chemotherapy group was 92.0%(23/25 patients),and 88.0%(22/25 patients)in the chemotherapy alone group(P>0.05).5.In the matched cohort,survival curves of patients in the surgery +chemotherapy group and chemotherapy alone group were analyzed.PFS and OS of patients in the surgery + chemotherapy group after treatment were both no significant difference between the two groups(P>0.05).6.Analysis of risk factors for post-treatment PFS in 50 patients in the matched cohort show that TFIp after the primary treatment is an independent prognostic factor for PFS in patients with platinum-sensitive recurrent ovarian cancer who did not achieve satisfactory tumor reduction(residual lesion > 1cm)after primary surgery.7.Analysis of risk factors for OS after treatment in in 50 patients in the matched cohort showed that the operation plan of the primary treatment,FIGO stage,pathological type,age of the first recurrence,TFIp and CA125 had no significant effect on OS after treatment.Conclusion:For the platinum-sensitive recurrent ovarian cancer patients who failed to achieve complete cytoreductive at the primary surgery(residual lesions > 1cm),compared to only treatment with the basis of the platinum drugs combination chemotherapy,underwent the optimal SCS(postoperative residual lesions < 1cm)followed by the basis of the platinum drugs combination chemotherapy can not prolong patients with postoperative PFS and OS.TFIp after the primary treatment is an independent prognostic factor for PFS in patients with platinum-sensitive recurrent ovarian cancer who did not achieve satisfactory tumor reduction(residual lesion > 1cm)after primary surgery.