Clinical Analysis Of Primary And Neoadjuvant Chemotherapy Followed By Debulking Surgery For Advanced Ovarian Cancer

Objective: The clinical data of patients with FIGO stage III and high grade serous ovarian cancer who first visited the Cancer Hospital of Xinjiang Medical University were analyzed retrospectively,to investigate the difference of 5-year survival rate and prognosis between primary debulking surgery and interval debulking surgery after neoadjuvant chemotherapy,the aim of this study is to provide reference for the individualized treatment of patients with advanced ovarian cancer.Methods: Retrospective analysis of1868 cases of FIGO stage III high-grade plasma ovarian cancer admitted to Xinjiang Medical University Cancer Hospital from January 2010 to October 2017,a total of 163 patients were included according to the inclusion and exclusion criteria,including two groups of PDS(85 cases)and NACT-IDS group(78 cases),to make the baseline balanced and comparable,the baseline data of the two groups were propensity matched In order to make the baseline balanced and comparable,the baseline data of the two groups were propensity matched,and 78 patients in each of the two groups after matching,and the basic data,surgery,postoperative related factors,and survival data of the two groups were compared,and the five-year survival rates of the two groups were statistically analyzed using SPSS software,and Kaplan-Meier and Cox et al.were used to investigate the FIGO stage III high-grade plasma ovarian cancer factors influencing the prognosis of patients.Results:(1)A total of 156 patients were included in this study,and 78 patients in each of the two groups were propensity-matched,and the baseline data showed that the groups were comparable(P > 0.05).(2)The rate of lymph node dissection(P=0.004)and postoperative complications(P=0.020)was higher in the PDS group than in the NACT-IDS group,and the difference between the groups was statistically significant.the rate of achieving no visual residual lesions intraoperatively was higher in the NACT-IDS group than in the PDS group,but the difference was not statistically significant(P>0.05),while the rates of bowel resection,positive lymph node metastasis,positive vascular surgical satisfaction rate were lower than those in the PDS group,and the differences were not statistically significant(P>0.05).(3)As of October 1,2022,the 3-year survival rate in this study was 76.92% in the PDS group compared with 62.54% in the NACT-IDS group,with a statistically significant difference(P=0.022);the 5-year survival rate was50.00% in the PDS group compared with 33.33% in the NACT-IDS group,with a statistically significant difference.The median survival time in the PDS group was 58months(95CI%: 42-74),with a mean survival time of 73±5 months.The median survival time in the NACT group was 40 months(95CI%: 32-48),with a mean survival time of59±5 months.(4)The results of the analysis of prognostic factors associated with 156 patients with FIGO stage III HGSOC showed that the choice of initial treatment modality was NACT(HR=1.754,95% CI: 1.187-2.590,P=0.005),positive vasculature(HR=1.628,95% CI: 1.016-2.608,P=0.043),postoperative presence of residual lesions(HR=1.757,95% CI: 1.064-2.903,P=0.028)as independent risk factors for OS.prognostic correlates of patients in the NACT-IDS group were analyzed and the results showed that the occurrence of postoperative complications(HR=2.255,95% CI: 1.060-4.795,P=0.035)was the independent risk factor.Conclusions: Patients with advanced high-grade plasmacytoma ovarian cancer treated with neoadjuvant chemotherapy followed by interval debulking surgery have poorer 5-year survival rates and survival times compared with primary debulking surgery.Neoadjuvant chemotherapy combined with interval debulking surgery can provide surgical opportunities for patients with advanced ovarian cancer with poor underlying physical status and high tumor load,improve the quality of patient survival by increasing the rate of surgical residual flesh-free lesions and reducing adverse perioperative complications,but did not significantly improve the prognosis of patients with advanced disease.