Analysis Of Factors Related To The Prognosis Of Ovarian Cancer And Health Economic Study

Objective:Ovarian cancer is the gynecological malignant tumor with the highest mortality rate.The possible influencing factors of ovarian cancer disease progression were analyzed,and the prediction model of disease progression was established to provide reference for clinical diagnosis and treatment.The characteristic of high recurrence rate makes the economic burden of ovarian cancer patients heavy.To measure the economic burden of ovarian cancer and explore the possible influencing factors that increase the economic burden.Cost-effectiveness analyze of neoadjuvant chemotherapy and primary cytoreductive surgery in the treatment of advanced epithelial ovarian cancer was conducted to provide reference for clinical decision-making.Methods:The information of inpatients diagnosed with ovarian cancer in the Third Affiliated Hospital of Kunming Medical University from January to December 2019 was collected,including:Serum carbohydrate antigen 199(CA199),carbohydrate antigen 125(CA125),human epididymis protein 4(HE4),albumin,grain leaching ratio(the ratio of neutrophils and lymphocytes),premenopausal Rome,Rome after menopause index,initial treatment site,the initial treatment,postoperative residual lesions,chemotherapy treatment,hospitalization expenses,outpatient expenses,etc.Non-parametric rank sum test and~2test were used to analyze the influencing factors of the disease progression of epithelial ovarian cancer.Binary Logistic regression model was used to establish the prognostic model of epithelial ovarian cancer.Non-parametric test and multiple linear regression were used to analyze the influencing factors of hospitalization cost of ovarian cancer.The direct non-medical burden of ovarian cancer patients during treatment was obtained through the economic burden of ovarian cancer questionnaire.To evaluate the indirect economic burden of ovarian cancer patients by human capital method combined with disability-adjusted life years.Use Treeage pro software to establish the new adjuvant chemotherapy compared to the initial tumor cells to destroy the loss in treatment of advanced epithelial ovarian cancer markov state transition model,the required parameters in the input model,through the analysis of the half cycle correction,back to take,queue simulation,cost-effectiveness analysis,sensitivity analysis method for economic evaluation of two kinds of treatments.Results1.Factors influencing the progression of epithelial ovarian cancerA total of 105 patients with epithelial ovarian cancer were followed up for disease progression,including 50 patients with disease progression and 55 patients without disease progression.1.1 Univariate analysis of disease progression in epithelial ovarian cancerPathological type,FIGO stage,CA125 level before initial treatment,HE4 level before initial treatment,ROMA index,albumin level before initial treatment,initial treatment method,residual lesions after surgery,and chemotherapy course are the influencing factors of ovarian cancer disease progression.The risk of ovarian cancer progression in patients with Figo stageⅣwas 3.926 times that in patients with Figo stageⅠ.The risk of ovarian cancer progression in patients with residual lesions after surgery was3.481 that in patients without residual lesions;The risk of ovarian cancer progression in patients with CA125≥670.6 KU/L before initial treatment was 4.421 times that in patients with CA125<670.6 KU/L.The risk of ovarian cancer progression in patients with HE4≥512pmol/L before initial treatment was 5.206 times higher than that in patients with HE4<512pmol/L.The risk of ovarian cancer progression was 4.7 times higher in patients with ROMA index≥93.965 than in patients with ROMA index<93.965.1.2 Multivariate analysis of the progression of epithelial ovarian diseasesAccording to the clinical characteristics of ovarian cancer,different indicators were selected and combined for multivariate analysis.The results showed:For every 1g/L decrease in albumin before initial treatment,the risk of disease progression increased 1.10-fold.Compared with FIGOⅠ,the risk of disease progression in FIGOⅢstage was 10.557times,and the risk of disease progression in FIGOⅣstage was 13.943 times.For each 1unit increase in HE4,the risk of disease progression increased 1.001-fold.1.3 The prediction model of"CA125 value before initial treatment+HE4 value after initial treatment+ROMA index"was established for the progression of epithelial ovarian cancer,with the corresponding AUC=0.734(95%CI:0.636-0.832),specificity 69.1%,sensitivity 72.0%and accuracy 70.5%.The risk of epithelial ovarian cancer progression was 5.748 times higher when the model score was>1 than when the score was≤1(95%CI:2.478-13.334).2 Preliminary study on health economics of ovarian cancer2.1 The total economic burden of the 403 ovarian cancer patients was 340.62 million yuan,of which the direct economic burden was 548.6 million yuan,including the hospitalization cost of 450.33 million yuan,the outpatient cost of 0.055 million yuan,and the direct non-medical burden of 400.2 million yuan.The indirect economic burden was285.75 million yuan,including 282.81 million yuan for patients and 0.029.4 million yuan for accompanying patients.2.2 Patient’s age,disease stage,surgery,length of stay and number of hospitalizations are the influencing factors of hospitalization costs of ovarian cancer patients,among which number of hospitalizations,length of stay,treatment methods and body mass index are the main influencing factors of hospitalization costs.2.3 The Markov model was established to analyze the cost-effectiveness of NACT compared with PDS in the treatment of advanced epithelial ovarian cancer.The cost of NACT was 201815.166 yuan,and the utility value was 8.56795.The initial cost of tumor cell reduction was 194925.3907 yuan,and the utility value was 8.2576.The ICER value of the incremental cost-effectiveness ratio of the two treatment plans was 22,205yuan/QALY,and the NACT plan had cost-effectiveness advantage within the set WTP value range.Conclusion1.Pathological type,FIGO stage,CA125 level before initial treatment,HE4 level before initial treatment,ROMA index,albumin level before initial treatment,initial treatment method,residual lesions after surgery,and chemotherapy course are the influencing factors of ovarian cancer disease progression.2.The economic burden of ovarian cancer patients is heavy.The hospitalization days,hospitalization times,treatment methods and body mass index of patients are the main influencing factors of the hospitalization cost of ovarian cancer.3.Neoadjuvant chemotherapy combined with intermediate cytoreductive surgery is more cost-effective in the treatment of advanced epithelial ovarian cancer.