| Objective(s): This study aims to collect the clinicopathological data of patients with Advanced epithelial ovarian cancer(AEOC)admitted to our hospital in the past 9 years,follow up their survival outcomes,and analyze the related factors affecting the recurrence of platinum-resistance and survival prognosis of AEOC patients.Based on the independent influencing factors,a nomogram prediction model was established to predict the recurrence of platinum-resistance and 1 year,3 years,and 5 years survival of AEOC patients,which provided a convenient quantitative tool for clinicians to early identify the recurrence risk population with high platinum-resistance and evaluate the prognosis of patients individually.Methods: A total of 2917 patients with ovarian cancer admitted to the Third Affiliated Hospital of Kunming Medical University from June 2013 to December2021 were screened.According to the inclusion and exclusion criteria,the clinicopathological data of 577 AEOC patients were finally collected and their survival outcomes were followed up.The recurrence-free Survival(RFS)and Overall survival(OS)were calculated.According to whether the RFS was less than 6 months,the patients were divided into platinum-resistant recurrence group and non-platinum-resistant group(including platinum-sensitive recurrence,partial platinum-sensitive recurrence and no recurrence).Univariate and multivariate Logistic regression analysis were used to screen the independent risk factors affecting the recurrence of platinum-resistant patients.Univariate and multivariate Cox regression analysis were used to screen the independent factors affecting the OS of patients.Based on the independent influencing factors,R language was used to establish prediction models for platinum-resistance recurrence and OS,which were visualized as Nomogram and web dynamic Nomogram.Bootstrap method was used for internal verification.The area under the ROC curve(AUC),Concordance Index(C-index),calibration curve and Decision curve analysis(DCA)were used to comprehensively evaluate the performance of the model.Results:1.A total of 577 patients were included in this study.The longest follow-up time was 117 months,the shortest was 6 months,and the median follow-up time was 33 months until December 31,2022.At the end of follow-up,378(65.5%)patients relapsed,130(22.5%)relapsed with platinum-resistance,447(77.5%)relapsed without platinum-resistance,and 198(34.3%)died.The median OS was 60 months(95%CI: 51.828-68.172).The median RFS was 16 months(95%CI: 13.978-18.022),5-year RFS was 21.8%,and 5-year OS was 49.3%.2.Compared with Neoadjuvant chemotherapy(NACT),patients undergoing Primary debulking surgery(PDS)have longer operation duration,more intraoperative blood loss,and longer postoperative hospital stay.However,the satisfactory tumor reduction rate was lower than that of NACT group(70.4%,88.4%).The median OS and RFS of the PDS group were higher than those of the NACT group(79 months 54 months,20 months 13 months),and the difference was statistically significant(P <0.05).The median OS of patients with satisfactory and unsatisfactory tumor reduction were 66 months(95%CI: 52.1-79.9)and 53 months(95%CI: 40.495-65.505)respectively.The median RFS were 19 months(95%CI: 15.891-22.109)and 10months(95%CI: 8.593-11.407),respectively.There were significant differences in OS and RFS between the two groups(P < 0.001,P=0.019).The median OS of the platinum-resistant group were shorter than those of the non-platinum-resistant group(28 months and 79 months),and the difference in survival between the two groups was statistically significant(P < 0.001).3.Univariate and multivariate Logistic regression analysis showed whether the tumor was bilateral ovarian simultaneity,FIGO stage,Time to first postoperative chemotherapy(P < 0.05),diameter of residual lesion,ascites,cycles of perioperative chemotherapy and half-life of CA125 were independent influencing factors for recurrence of platinum-resistance in AEOC patients.Based on the above indicators,a prediction model for the recurrence of platinum-resistance in AEOC patients was constructed and visualised as a Nomogram and a web dynamic Nomogram.Further internal validation by Bootstrap method showed that the AUC of the model was0.791(95%CI:0.747-0.835),suggesting that the model had a good discrimination.The calibration curve and the standard curve were basically consistent,and both of them were basically around the ideal curve.DCA showed that the net benefit interval of the model for predicting recurrence of platinum resistance was 0.037-0.8.4.Univariate and multivariate Cox regression analysis showed that in addition to the number of perioperative chemotherapy courses,the independent risk factors of platinum-resistant recurrence were independent risk factors for OS.In addition,PLR(platelet count/lymphocyte count)and PNI(prognostic nutritional index)were also independent factors for OS of AEOC patients at initial diagnosis.Based on the above indicators,the prediction model of OS of patients was constructed and visualized as a Nomogram and a network dynamic Nomogram.The C-index of internal validation of the model was 0.745(95%CI: 0.702-0.789),and the AUC of predicting 1 year,3 years,and 5 years OS were 0.796(95%CI: 0.716-0.876)and 0.746(95%CI: 0.696-0.798),0.773(95%CI: 0.713-0.833).The calibration curve was close to the standard curve.The net benefit intervals of DCA in predicting 1 year,3 years,and 5 years survival of AEOC patients were(0.001-0.072),(0.014-0.724),and(0.258-1).Conclusion(s):1.NACT can reduce the tumor burden,increase the satisfactory tumor reduction rate and improve the short-term efficacy,but there is no significant improvement in OS and RFS.Satisfactory cytoreductive surgery can significantly improve the OS and RFS of patients,and it plays an important role in preventing the recurrence of platinum-resistant tumor.Platinum-resistant recurrent AEOC patients have shorter survival time and worse prognosis.2.Patients with bilateral ovarian tumors,FIGO stage IV,TTC > 23 days,ascites >1000ml,perioperative chemotherapy cycles > 9 times,surgery did not reach R0 resection,CA125 half-life > 52 days are more likely to develop platinum-resistant recurrence.The above seven indicators are independent influencing factors of platinum-resistant recurrence in patients with AEOC.3.AEOC patients with bilateral ovarian tumors,FIGO stage IV,TTC > 23 days,ascites > 1000 ml,PLR > 233,PNI < 56,surgery did not reach R0 resection,CA125half-life > 53 days have shorter OS.4.The nomogram prediction models constructed in this study can predict the recurrence of platinum-resistance and overall survival.Internal validation showed that the two models had good discrimination,calibration and clinical applicability,which could predict the recurrence risk of platinum-resistance and survival prognosis of AEOC patients after initial treatment. |
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