| ObjectivesTo evaluate the therapeutic effects,recurrence and survival status of neoadjuvant chemotherapy combined with interval debulking surgery(NACT-IDS)in comparison with primary debulking surgery(PDS).And to explore the prognostic factors in advanced epithelial ovarian cancer.MethodsThe clinical data of 109 patients with epithelial ovarian cancer in FIGO stage III or IV treated in Qilu Hospital of Shandong University from January 2015 to December 2016 were retrospectively analyzed.The patients were divided into two groups according to their primary treatment:NACT-IDS group and PDS group.Using SPSS 25.0 to compare and analyze the clinical characteristics,perioperating factors,first-line treatment outcomes et al.in two groups with the aim of exploring the advantages and disadvantages of NACT-IDS.The recurrence and survival status were analyzed by Kaplan-Meier method and COX proportional hazard regression model to explore the risk factors of progression free survival(PFS)and overall survival(OS)in patients with advanced epithelial ovarian cancer.Results1.Clinical characteristicsAmong the 109 patients with advanced epithelial ovarian cancer,there were 33 cases(30,28%)in NACT-IDS group and 76 cases(69.72%)PDS group.There was no significant difference in age,FIGO stage,pathological type,ascites and retroperitoneal lymph node resection between the two groups(P>0.05).However,the level of CA125 before treatment in NACT-IDS group was higher than that in PDS group(median 1340.00U/ml versus 678.95U/ml,P=0.019),and the albumin level before treatment in NACT-IDS group was lower than that in PDS group(median 36.3g/L versus 39.6g/L,P<0.001).2.Perioperating factorsIn NACT-IDS group,the intraoperative blood loss was less(median 300 ml versus 400ml,P=0.024),and the blood transfusion rate was significantly lower(36.36%versus 75.0%,P<0.001)than that in PDS group.The differences in operation time between NACT-IDS group and PDS group(median 130min versus 140min P=0.446)and intestinal resection rate(0 versus 6.58%,P=0.131)had little statistical significance.3.First-line treatment outcomesIn NACT-IDS group,81.82%(27/33)of patients achieved complete response,6.06%(2/33)were partial response(6.06%)and 12.12%(4/33)ungerwent stable or progressive disease.In PDS group,the proportion of different response status above were 81.58%(62/76),6.58%(5/76)and 11.84%(9/76)respectively.The objective response rate(ORR)after first-line treatment was in no significant difference between the two groups(87.88%versus 88.16%,P=0.967).4.RecurrenceBy the end of follow-up,in NACT-IDS group the median PFS was 14.0 months,27.27%(9/33)of patients had no recurrence,39.40%(13/33)were platinum-sensitive recurrence,21.21%(7/33)were platinum-resistant recurrence and 12.12%(4/33)were refractory recurrence.In PDS group,the median PFS was 14.0 months,and the proportion of different recurrence status above were 27.63%(21/76),36,84%(28/76),23.68%(18/76)and 11.85%(9/76)respectively.There was no significant difference in PFS,recurrence rate and platinum-resistant recurrence rate between the two groups(P>0.05).5.Survival statusThere was no significant difference on OS between the two groups(median 40.0 months versus 40.0 months,P=0.756)by the end of follow-up.The one-year survival rate in NACT-IDS group and PDS group were 96.97%and 93.42%respectively,the two-year survival rate was 69.70%and 67.11%,and the three-year survival rate was 60.61%and 63.16%.The difference of all the survival rates between two groups were of no significance(P>0.05).6.Analysis ofp rognosis-related factorsThe Analysis of prognosis-related factors of 109 patients with advanced epithelial ovarian cancer showed that ascites(HR 3.328,95%CI:1.443?7.675;P=0.005)and high-grade serous carcinoma(HR 2.075,95%CI:1.039-4.143;P=0.039)were independent risk factors for PFS.?50 years old(HR 2.594,95%CI:1.167?5.765;P=0.019),ascites(HR 4.03,95%CI:1.218?13.359;P=0.022),and retroperitoneal lymph nodes histological metastasis(HR 5.06,95%CI:1.175-21.845;P=0.030)were independent risk factors for OS.Retroperitoneal lymphadenectomy is a factor for OS(P=0.026),but not an independent factor.There was no significant influence on PFS and OS in treatment,CA125 or albumin levels before treatment and intestinal resection in this study(P>0.05).Conclusions1.Our study showed that compared with PDS,patients treated with NACT could suffer less blood loss during debulking surgery and had less possibility of blood transfusion.2.The outcome of first-line treatment,recurrence and prognosis in patients with NACT-IDS were similar to those with PDS.NACT neither reduced the objective response rate of first-line treatment nor increased the risk of platinum-resistant recurrence.Additionally,NACT-IDS did not significantly improve PFS and OS in patients with advanced epithelial ovarian cancer.3.For patients with advanced epithelial ovarian cancer,ascites and high-grade serous carcinoma were independent risk factors for PFS,while over 50 years old,ascites and retroperitoneal lymph node histological metastasis were independent risk factors for OS.4.For patients treated with NACT-IDS,the degree of decrease in CA125 was an independent factor for PFS.Those achieving a decrease more than 90%in CA125 before IDS had significantly improved PFS. |
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