| Objective(s):Surgery and postoperative platinum-based chemotherapy are currently the standard treatment for epithelial ovarian cancer(EOC).This study aims to investigate the timing of the start of chemotherapy after surgery for patients with epithelial ovarian cancer.The prognosis of patients with epithelial ovarian cancer influences.Methods:A retrospective analysis of the clinical medical records of patients with epithelial ovarian cancer initially treated in the Third Affiliated Hospital of Kunming Medical University/Yunnan Cancer Hospital from January 2013 to December 2017 Subtractive surgery followed by 6-8 cycles of paclitaxel+carboplatin intravenous chemotherapy.Record the patient’s age,pathological type,stage,operation time,operation method,residual lesion size during operation,postoperative complications,chemotherapy start date and chemotherapy plan,etc.The last follow-up time was January 20,2020.The median progression-free survival time(PFS)and time to chemotherapy(TTC)were calculated.The relationship between TTC and PFS in patients with epithelial ovarian cancer was analyzed.Time to chemotherapy(TTC)is defined as the time interval from surgery to the beginning of the first chemotherapy.Results:1.A total of 265 patients with epithelial ovarian cancer were included in this study,with an age range of 18-71 years,with an average age of(50.8 ± 8.29)years;stage:45 cases in stage Ⅰ(16.9%)and 35 cases in stage Ⅱ(13.2%),156 patients(58.8%)in stage Ⅲ and 29 patients(10.9%)in stage Ⅳ;follow-up to January 20,2020,a total of 138 patients(52.1%)relapsed and 6 patients(2.3%)were lost to follow-up.The median PFS is 39.77 months.2.TTC distribution:In this study,TTC ranged from 5 to 93 days,with an average number of days of 29.05 ± 12.15 days.34 patients received chemotherapy within 2 weeks after operation,29 patients received chemotherapy within 2-3 weeks,66 patients received chemotherapy within 3-4 weeks,70 patients received chemotherapy within 4-5 weeks,and 36 patients received chemotherapy within 5-6 weeks 25 patients received chemotherapy within 6-8 weeks,and 5 patients received TTC＞8 weeks.The median number of days in TTC is 29 days,and the interquartile range(IQR:22-35 days).In this study,TTC was divided into three groups according to the quartile range.The intermediate group was 25%to 75%(TTC:23-35 days)and the delayed group was 75%(TTC＞35 days)for comparison.3.Comparison of general conditions:general characteristics of patients in the whole cohort(age of diagnosis,combination of underlying diseases,medical insurance type,pathological type,FIGO stage,histopathological classification and lymph node metastasis),etc.,no statistically significant difference was found between the three groups.4.Comparison of surgical conditions:The results show that postoperative complications(P＜0.001),prolonged postoperative hospital stay(P＜0.001)and more ascites(P＜0.001),the patient’s TTC is more prolonged(TTC＞35 Days);however,there was no significant difference in TTC between patients with residual lesions,lymph node dissection,and expanded tumor cytoreductive surgery(P＞0.05).5.Univariate analysis showed that postoperative residual lesions,FIGO stage,histopathological grading,serum CA125 and ascites cytology before treatment were the risk factors affecting PFS.The results of multivariate analysis showed that:FIGO stage(HR=2.233,95%CI:1.301-3.832,P=0.004),surgical residual lesions(HR=0.595,95%CI:0.404-0.877,P=0.009)affect epithelial Independent risk factors for PFS in ovarian patients.6.The effect of TTC on the prognosis of patients with epithelial ovarian cancer Of the 265 patients in this study,71 had TTC≤22 days,of which 35 had recurrence(50.0%);the median progression-free survival was 45.80months;129 had TTC between 23 and 35 days,of which 57 had recurrence(44.18%),with a median PFS of 54.23 months;65 patients with TTC＞35 days,of which 45 cases(68.18%)relapsed,with a median PFS of 32.37 months,and PFS between the three groups(Log-rank χ2=6.983,P＝0.030)The difference is statistically significant.After adjusting for independent factors affecting PFS(surgical residual lesions and FIGO staging)in patients with epithelial ovarian cancer in a multivariate analysis,compared with patients in the TTC intermediate group(23-35 days),patients with TTC ≤ 22 days relapsed HR was 1.110(95%CI:0.726-1.697),P=0.630,and HR of patients with TTC>35 days was 1.902(95%CI:1.284-2.819),P=0.001,that is,patients with TTC≤22 days and TTC Compared with patients in the middle group(23-35 days),the risk of recurrence did not increase significantly(P＞0.05).Compared with the TTC intermediate group(23-35 days),the risk of recurrence of TTC>35 days group was significantly increased(P＜0.05),the difference was statistically significant.7.The FIGO stage was used as a subgroup for analysis.The results showed that for patients with stage Ⅰ-Ⅱ epithelial ovarian cancer,refer to patients in the TTC intermediate group(23-35 days),TTC early group(≤22 days)and TTC delayed group(＞35 Days),the risk of recurrence was not significantly increased,and the difference was not statistically significant.For patients with stage Ⅲ-Ⅳ epithelial ovarian cancer,refer to patients in the TTC intermediate group(23-35 days),TTC delayed group(＞35 days)Of patients had an HR of 1.685(95%CI:1.084-2.620,P=0.020),suggesting that patients with TTC>35 days had significantly higher risk of recurrence than patients with TTC(23-35 days),the difference was statistically significant Significance(P＜0.05);Compared with TTC(23-35 days)group,the risk of recurrence was not significantly increased in patients with TTC≤22 days group,and the difference was not statistically significant.8.The residual lesions after surgery were analyzed as a subgroup.The results showed that for patients with epithelial ovarian cancer without residual lesions after surgery,refer to patients in the TTC intermediate group(23-35 days),patients in the TTC delayed group(＞35 days)The HR was 1.959(95%CI:1.043-3.681,P=0.037),suggesting that for patients with no residual residual lesions after surgery,patients with TTC＞35 days had a significantly higher risk of recurrence than patients with TTC(23-35 days)High,the difference is statistically significant;for patients with epithelial ovarian cancer whose residual lesions after surgery are RD≤lcm and RD＞1cm,refer to patients in TTC intermediate group(23-35 days),early TTC group(≤22 days)and TTC In the delayed group(＞35 days),the risk of recurrence did not increase significantly,and the difference was not statistically significant(P>0.05).9.Subgroup analysis results of other influencing factors showed that the effect of TTC on PFS in patients with epithelial ovarian cancer was not significantly different in subgroups such as histopathological grade,CA125 level before treatment,ascites cytology,and lymph node involvement(P＞0.05).Conclusion(s):1.Prolonged postoperative hospital stay,postoperative complications,and large amount of ascites are the factors affecting the delay of postoperative adjuvant chemotherapy in patients with epithelial ovarian cancer.2.The median PFS of patients with TTC＞35 days was significantly lower than those with TTC between 23-35 days;multivariate analysis showed that patients with TTC＞35 days had a higher risk of recurrence than those with TTC between 23-35 days,and early(TTC≤22 days)patients who started chemotherapy had no significant difference in recurrence risk compared with patients in the intermediate group(TTC:23-35 days).3.The results of the subgroup analysis indicate that for patients with advanced epithelial ovarian cancer and patients without residual macroscopic lesions after surgery,those with TTC＞35 days have a higher risk of recurrence.4.For patients with epithelial ovarian cancer with no gross residual lesions after advanced(stage Ⅲ-Ⅳ)surgery,compared with patients with TTC≤22 days and TTC＞35 days,PFS with chemotherapy in 23-35 days after surgery is more ideal. |
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