Clinical Retrospective Study Of 129 Cases Of Hereditary Ovarian Cancer

Objective:The clinical data of 129 cases of hereditary ovarian cancer were reviewed,their clinical characteristics were summarized and the factors affecting their prognosis were analyzed in order to enrich the research data of hereditary ovarian cancer and understand this special group of patients with hereditary ovarian cancer more comprehensively.Methods:129 cases of hereditary ovarian cancer treated in the Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University from January,2006 to December,2021 were included.Among them,66 cases had a positive history of ovarian cancer in their first-degree relatives and 65 cases were double primary breast-ovary cancer.Their information was obtained through medical record system and follow-up office data of obstetrics and gynecology.The information Includes the age of onset and menopause,pregnancy and parity,family history and personal history of malignant tumor,blood routine test before treatment,CA125 level and ascites before treatment,surgical records,postoperative pathological report,detection of BRCA gene,chemotherapy and maintenance treatment,recurrence and the last follow-up.The study population was divided into groups according to the history of ovarian cancer in the first-degree relatives and personal history of breast cancer.Clinical features of 129 cases of hereditary ovarian cancer were analyzed retrospectively.The factors affecting progression-free survival and the predictive effect of inflammatory indexes on progression-free survival were also discussed.Results:Among the 129 cases of hereditary ovarian cancer,66 cases had a positive history of ovarian cancer in their first-degree relatives and 65 cases had breast-ovarian double primary cancer.The average age of onset of ovarian cancer was 53.3 years old,the detection rate of BRCA1/2 gene was 48.8%,and the positive rate was 81.0%.The median CA125 before treatment was 592.05 U/ml.The rate of neoadjuvant chemotherapy was 16.3%,and the satisfaction rate of operation was 84.3%.High-grade serous carcinoma accounted for 89.1%,and the main stage was Ⅲ-Ⅳ stage,accounting for 65.9%.The remission rate of first-line chemotherapy was 97.5%.The median follow-up time was 29 months.At the last follow-up,50.4%of the cases had suffered from the first recurrence,69.2%of whom were platinum-sensitive and 30.8%were platinum-resistant.The median PFS was 17months.Univariate analysis showed that there were significant differences in median PFS according to ovarian cancer history of the first-degree relatives(P<0.009),breast cancer history(P<0.019),initial ascites volume(P<0.005),CA125 level before treatment(P<0.001),operation satisfaction(P<0.001),tumor pathological stage(P<0.001)and first-line chemotherapy evaluation(P<0.001).COX regression analysis showed tumor stage(OR=2.127,95%Cl 1.040-4.347,P=0.039)and surgical satisfaction(OR=2.208,95%CI 1.028-4.741 and P=0.042)were independent predicting factors of PFS.The median NLR of the first-degree relatives with positive history of ovarian cancer was higher than that of the negative group(P=0.013),and the median LMR of the positive group was lower than that of the negative group(P=0.016).When CA125<500U/ml,the median PFS of group-NLR ≤2.9 was longer than that of group-NLR>2.9,and the median PFS of group-LMR≤3.8 was shorter than that of group-LMR>3.8(P<0.002).Conclusion:1.HOC has the characteristics of early age of onset,late stage of diagnosis,easy to be complicated with other primary malignant tumors,high-grade serous carcinoma and high mutation rate of BRCA gene,but its PFS is longer than that of sporadic ovarian cancer.2.Positive history of ovarian cancer,no personal history of breast cancer,ascites volume before treatment>500ml,pre-treatment CA125>500U/ml,unsatisfactory operation,tumor stage Ⅲ-Ⅳ and failure to reach CR in first-line chemotherapy all suggest shorter PFS;.Ⅲ-Ⅳstage and unsatisfactory operation are independent predictors of shorter PFS.3.The diagnosis stage of HOC patients with positive ovarian cancer history in first-degree relatives is later than that in patients with negative ovarian cancer history in first-degree relatives.4.The age of the first cancer in patients with breast-ovarian double primary cancer is younger than that in patients with non-double primary cancer,and ovarian lesions are more likely to be found by routine physical examination;the PFS of the former is longer than that of the latter,but the interval between two cancers is not significantly related to PFS;the main cause of death in patients with double primary cancer is ovarian cancer.5.There is a significant correlation between NLR,LMR and CA125 before treatment.When CA125 before treatment<500U/ml,PFS is shorter in patients with high NLR or low LMR.