| Objective: The intention of this research was to explore the value of controlled nutritional status(CONUT)score,lactate dehydrogenase to albumin ratio(LAR),platelet distribution width to platelet count ratio(PPR)in recurrence and prognosis of patients with epithelial ovarian cancer(EOC),so as to assist clinical decision-making and formulate individualized treatment plan,and afford reference for clinical management and prognosis evaluation of epithelial ovarian cancer patients.Methods: The clinical data of 151 EOC patients confirmed by postoperative pathology after in primary cytoreductive surgery in the Department of Gynecology of the First Hospital of Lanzhou University from December 2016 to December 2021 were retrospectively collected.The CONUT score,LAR and PPR were calculated.The patients were followed up by outpatient or telephone to record whether there was recurrence,time of recurrence,survival status and time of death,the follow-up ended in November 2022.The CONUT score was grouped according to the risk of malnutrition.LAR,PPR,carbohydrate antigen 125(CA125)and human epididymis protein 4(HE4)were grouped according to the optimal cut-off value of the receiver operating characteristic(ROC)curve to predict the postoperative survival of patients.Chi-square test was used to compare the general clinical data between groups.Kaplan-Meier approach and log-rank test were used to compare the progression-free survival(PFS)and overall survival(OS)of EOC patients between each index group.Cox proportional hazard regression model was used to explore the independent risk factors affecting PFS and OS in EOC patients.The area under the ROC curve(AUC)was employed to compare the predictive ability of related factors for recurrence and death.Results:1.There was no significant difference in age,body mass index(BMI),menopausal status,ascites,pathological category,FIGO stage,tumor differentiation,lymph node metastasis and postoperative residual lesions between the CONUT score groups(P>0.05).There were significant differences in age,BMI,menopausal status,ascites and lymph node metastasis between PPR groups(P<0.05).There were significant differences in ascites,pathological category,FIGO stage,tumor differentiation and postoperative residual lesions,CA125 and HE4 between LAR groups(P<0.05).2.The affecting elements of PFS in EOC patients were analyzed.Univariate analysis showed that ascites,serous pathological type,FIGO stage III～IV,poor tumor differentiation,lymph node metastasis,postoperative residual lesion ≥ 1 cm,preoperative high CONUT score,high LAR,high CA125,high HE4 were risk factors for PFS(P<0.05).Multivariate analysis showed that postoperative residual lesion ≥ 1cm(HR=6.153,95% CI: 3.059～12.374,P<0.001)and preoperative high HE4(HR=1.001,95% CI: 1.000～1.001,P=0.004)were independent risk factors for PFS.3.The affecting elements of OS in EOC patients were analyzed.Univariate analysis showed that ascites,serous pathological type,FIGO stage III～IV,poor tumor differentiation,lymph node metastasis,postoperative residual lesion ≥ 1 cm,preoperative high CONUT score,high LAR,low PPR,high CA125,high HE4 were risk factors for OS(P<0.05).Multivariate analysis showed that postoperative residual lesions ≥ 1 cm(HR=8.674,95% CI: 13.366～22.349,P<0.001),preoperative high CONUT score(HR=1.209,95% CI: 1.048～1.395,P=0.009),preoperative high LAR(HR=1.022,95% CI: 1.008～1.036,P=0.002)were independent risk factors for OS.4.The AUC of CONUT score,LAR,PPR,CA125 and HE4 alone in predicting PFS in patients with EOC patients were 0.610,0.688,0.642,0.666 and 0.748,respectively;the AUC for predicting OS were 0.670,0.740,0.669,0.623 and 0.719,respectively.The AUC of CONUT score combined with CA125 and HE4,LAR combined with CA125 and HE4,PPR combined with CA125 and HE4,CA125 combined with HE4 in predicting PFS of EOC patients were 0.765,0.763,0.763 and0.757,respectively.The AUC for predicting OS were 0.741,0.758,0.762 and 0.712,respectively.Compared with CONUT score,LAR,PPR,CA125 and HE4 alone,the combined indicators had higher predictive value for PFS and OS of EOC.Conclusion:1.Postoperative residual lesion ≥ 1 cm and preoperative high HE4 are independent risk factors for PFS in EOC patients,postoperative residual lesion ≥ 1 cm and preoperative high CONUT score,high LAR are independent risk factors for OS in EOC patients;2.Preoperative high PPR is a protective factor for EOC patients.The higher the preoperative PPR,the longer the OS;3.In terms of recurrence of EOC,HE4 prediction performance is better than CONUT score,LAR and CA125;in terms of death of EOC,LAR prediction performance is better than CONUT score,PPR and CA125,HE4;4.Among the combined indicators,CONUT score combined with CA125 and HE4 has the highest value in evaluating the recurrence of EOC patients.PPR combined with CA125 and HE4 has the highest value in evaluating the death of EOC patients. |
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