| Background Ovarian cancer is a common cancer of the female reproductive system,and epithelial ovarian cancer is the most lethal cancer of the female reproductive tract.The current standard treatment for advanced ovarian cancer is surgery and platinum-based chemotherapy.Ovarian cancer has a poor prognosis because about 70% of women diagnosed with advanced disease that have spread to the abdomen and are difficult to achieve satisfactory cytoreductive surgery.In order to improve the survival of patients,neoadjuvant chemotherapy has been used in patients with ovarian cancer,but whether neoadjuvant chemotherapy can benefit patients is still controversial.Neoadjuvant chemotherapy is defined as a series of cycles of chemotherapy before surgery to reduce the tumor load,reduce tissue edema,and reduce tissue adhesion in order to increase the probability of achieving satisfactory cytoreductive surgery.For advanced epithelial Ovarian Cancer,neoadjuvant chemotherapy is used when the Primary Debulking Surgery can not achieve satisfactory results or when the patient is not in a good physical condition and can not accept the Primary Debulking Surgery,an alternative chemotherapy option before Intermittent Debulking Surgery.Chemotherapy is critical for patients with epithelial ovarian cancer,most patients are sensitive to platinum-based chemotherapy,but about 20% of patients are resistant to platinum when receiving chemotherapy for the first time,and timely administration of sensitive chemotherapy regimens is extremely important,there are no clear indicators or markers that can predict chemosensitivity in ovarian cancer patients.CD40 belongs to the superfamily of tumor necrosis factor receptors,and some studies have shown that the expression of CD40 in malignant tumors increases,and its expression is related to the prognosis of malignant tumors.Purpose To explore whether neoadjuvant chemotherapy could benefit patients with advanced epithelial ovarian cancer by analyzing the clinical data of neoadjuvant chemotherapy group and initial cytoreductive therapy group.The expression of CD40,VEGF and CD34 in advanced epithelial ovarian cancer was determined by Immunohistochemistry,and the relationship between CD40 and neoadjuvant chemotherapy sensitivity was analyzed by clinical effect and CD40 expression.Method Part I: 90 patients with advanced epithelial ovarian cancer who were treated in Henan Provincial People's Hospital from January 2016 to January 2019 were selected,with FIGO stage IIIC-IV.According to the patient's condition and the patient's own choice,they were divided into an observation group and a control group.A total of 40 patients in the observation group underwent neoadjuvant chemotherapy + Intermittent Debulking Surgery,and a total of 50 patients in the control group underwent Primary Debulking Surgery.The patients in both groups were supplemented with paclitaxel / docetaxel + carboplatin / cisplatin(TC / TP)regimen for 6-8 courses of chemotherapy in accordance with NCCN guidelines.The intraoperative conditions and the rate of satisfactory cytoreductive surgery were compared between the two groups to evaluate the advantages of neoadjuvant chemotherapy.Part II: The ovarian tissue samples from 90 patients with ovarian cancer and 5 patients with uterine Leiomyoma who underwent hysterectomy and bilateral adnexectomy were selected as normal control group.The specimens were fixed in 4% paraformaldehyde for 24 hours,rinsed with running water for 4-6 hours,dehydrated with gradient alcohol,transparent with xylene,dipped in wax and made into wax blocks.The staining results were analyzed under the microscope.To investigate the expression of CD40,VEGF and CD34 in Ovarian Carcinoma,and to analyze whether the expression of CD40 is related to angiogenesis or chemosensitivity of Ovarian Carcinoma.Result Part I: There was no significant difference in age,CA125 value and Figo stage between the two groups(P>0.05).The operation time of the observation group was shorter than that of the control group(P<0.01),the bleeding amount in the observation group was shorter than that of the control group(P<0.05),the ascites rate in the observation group was 72.00%,lower than the control group(the ascites ratio was 82.00%),but there was no significant difference between the two groups(P>0.05).The ratio of residual cancer focus less than 1 cm in the observation group was 72.50%,which was significantly higher than that in the control group(44.00%),and the difference between the two groups was statistically significant(P<0.05).The total effective rate of the observation group was 62.50%(25 / 40),higher than that of the control group(38.00%(19 / 50),the difference was statistically significant(P=0.021).Part II: The expression of CD40,VEGF and CD34 were negative in normal ovary.The positive rates of CD40,VEGF and CD34 in the observation group were lower than those in the control group(P<0.001).The total effective rate of the observation group was 62.50%(25 / 40),and the positive rate of CD40 in the effective group was 48.00%(12 / 25),which was lower than that in the ineffective group(93.30%(14 / 15),and the difference was statistically significant(P=0.004).VEGF was expressed in 41 of 43 CD40 positive cases in control group and in 3 of 7 CD40 negative cases.Pearson Correlation Analysis showed a positive correlation between CD40 and VEGF expression(r=0.442,P<0.001).In the control group,40 cases were CD40 positive and 5 cases were CD34 negative in 7 cases.Pearson Correlation Analysis showed that CD40 was positively correlated with CD34 expression(r= 0.610,P<0.001).CD34 + MVD was 16.14±4.88 in 43 CD40 positive patients in control group,higher than that in 7 CD40 negative patients(11.00±3.78),and the difference was statistically significant(P=0.012).In conclusion 1.NACT is a valuable treatment option for patients with advanced epithelial ovarian cancer,especially for patients with high tumor load or older and poor health.2.CD40 may play an important role in the occurrence,development and metastasis of ovarian cancer by participating in angiogenesis.It may become a targeted therapy point.3.CD40 can predict the chemosensitivity of ovarian cancer patients receiving neoadjuvant chemotherapy. |
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