Prediction Of Tumor Response Induced By Chemotherapy And Prognosis Using Ascites Volume And Serum CA125 Kinetics In High-Grade Serous Ovarain Cancer

Background and Objectives:Ovarian cancer is one of the three major gynecological malignancies.Its epidemiological characteristics are high recurrence rate,high mortality rate,and low survival rate.Epithelial ovarian cancer(EOC)is the most common type of ovarian cancer,accounting for about 90% the incidence of ovarian cancer.The 5-year survival rate is only 46%,and the 5-year survival rate of advanced patients is only 29%.The most common pathological type in epithelial ovarian cancer is serous ovarian cancer,accounting for about 52% of EOC patients.One of the most common and most fatal is high-grade serous ovarian cancer(HGSOC).Since there are no obvious symptoms in the early stage of the disease,about two-thirds of patients are diagnosed as late.For patients with advanced HGSOC,the most common symptom is abdominal distension caused by ascites,more than one-third at the time of initial diagnosis ascites is present,ascites are present in almost all cases of recurrence at the same time.Serum CA125 is currently considered to be a tumor biomarker that is more sensitive to HGSOC.The kinetic changes of serum CA125 during treatment can reflect the residual status of the tumor in the patient and can indicate the platinum resistance and recurrence of the tumor at a relatively early stage.Therefore,this study aimed to explore the value of serum CA125 kinetics and ascites volume in predicting HGSOC platinum sensitivity and prognosis.It is expected to provide judgment basis for the personalized treatment plan of clinical treatment of HGSOC and improve the survival rate of patients.Materials and Methods:The clinicopathological data of 131 patients with stage II-IV high grade serous ovarian cancer who received primary surgical and follow-up platinum-based chemotherapy were retrospectively analyzed.A cut-off value of ascites volume and serum CA125 negative time for predicting platinum-resistant in HGSOC was determined by using the receiver operating characteristic curve and the Youden index.Univariate analysis was performed to determine the correlation between ascites volume,serum CA125 dynamics and prognosis in HGSOC.A multivariate Cox proportional regression model was used to calculate the hazard ratios(HR)and 95% confidence intervals(CI)for progression-free survival(PFS)and overall survival(OS)after controlling for potential confounding factors.Result : In all,131 patients were included.The receiver operating characteristic curve showed that the optimal cut-off value of ascites volume and serum CA125 negative time for predicting platinum-resistant in HGSOC were 850 ml and 96.5 days.The multivariate Cox regression analysis demonstrated that FIGO stage(P=0.046),ascites volume(P=0.01),peritoneal metastasis(P=0.007)and Start time of chemotherapy(P=0.000)were independent prognostic factors in terms of Progression-Free-Survival(PFS).The ascites volume(P=0.025)and serum CA125 half-life(P=0.008)were identified as independent prognostic factors for Overall Survival(OS).Conclusion:The ascites volume and serum CA125 negative time was demonstrated to be a useful platinum sensitivity predictive factor in patients with HGSOC,and the ascites volume over 850 ml or the serum CA125 negative time over 96.5 days was optimal cut-off value for predicting platinum-resistant.At the same time the ascites volume and serum CA125 kenitics is the most important independent prognostic factor in patients with HGSOC.Ascites volume and the kinetic changes of serum CA125 can predict the sensitivity of patients to platinum-based chemotherapy and the long-term prognosis,and provide a theoretical basis for clinical personalized treatment of HGSOC patients,in order to improve the survival rate of patients.