| Objective: To investigate the clinical characteristics of patients with mucinous ovarian carcinoma(MOC),to explore the independent risk factors affecting the prognosis of MOC patients,and to construct a Nomogram model that can individually predict the overall survival of MOC patients,so as to help clinical gynecological oncologists diagnose and analyze and choose individualized treatment plans for different patients to achieve precision medicine.Methods: Ⅰ.Modeling data: The clinical data of 1037 patients with MOC diagnosed in the SEER database(Surveillance,Epidemiology,and End Results,SEER)of the National Cancer Institute from 2010 to 2017 were collected.SPSS26.0 was used to analyze the clinical characteristics of the patients,and the patients were randomly divided into training cohort and validation cohort at a ratio of 7:3.Univariate and multivariate Cox regression analysis on the variable factors to screen out the independent influencing factors affecting the survival outcome of patients with ovarian mucinous carcinoma(P < 0.05).Using R language software to construct Nomogram clinical prediction model.Calibration and clinical validity of the new model were evaluated using Concordance index(C-index),Area under curve(AUC)and Calibration curves.II.External validation data: The complete data of patients with MOC diagnosed in Shengjing Hospital of China Medical University from November 1,2014 to February 28,2021 were retrospectively analyzed,and the related factors affecting the prognosis of patients and the pregnancy outcome of patients with fertility preservation were discussed.SPSS26.0 software to statistical processing and analysis of data,measurement data and descriptive statistical analysis were using mean,standard deviation,etc.Chi-square test / Fisher ’s exact test was used to compare categorical variables and inter-group rates.Recurrence,death or pregnancy were used as endpoint events.Kaplan-Meier survival method was used to analyze the univariate survival curve.Log-Rank test was used to compare the difference of survival rate.Cox proportional hazards model and Logistic regression model were used for multivariate analysis The test level was α = 0.05.Through this part of the data,the established nomogram clinical prediction model is externally verified.Results: Ⅰ.Modeling data: Age,tumor location,stage,number of lymph node dissection and tumor size were independent influencing factors of survival outcome.Based on the above factors,a prediction model of overall survival time in MOC patients was constructed.The C index of the training cohort,internal validation cohort and external validation cohort were 0.859,0.841 and 0.770,respectively.The 1-year,3-year and 5-year AUC were0.906,0.882,0.862 and 0.875,0.890,0.848 and 0.953,0.796,0.783,respectively.The calibration curve shows that the predicted survival state of the model is in good agreement with the actual situation.The scores of each patient were calculated by the model and divided into high-risk group and low-risk group with the median value as the boundary.The difference of Kaplan-Meier curve between subgroups was statistically significant.II.External verification data: 1.There were 78 patients with a median age of onset of 48(11-91)years old.Patients mostly complained of abdominal pain(17 cases,21.79%).More patients were diagnosed at early stage,with 65.38% diagnosed as FIGO Stage I.2.As of the end of the follow-up date,there were 36 patients who had been followed up for more than five years,with a median survival time of 66(2–95)months and 11 deaths.The fiveyear survival rate was 69.44%,and the five-year survival rate of stage I patients was86.96%,and the five-year survival rate of patients with stage II-IV is 22.22%.3.Including re-staging surgery,24 patients finally underwent fertility-preserving surgery,6 cases relapsed(5 cases died).The median age of the 19 patients was 26(11-36)years old.By the end of the follow-up period,13 patients had fertility requirements,and 8 patients had 9pregnancies in total,with a pregnancy rate of 69.23%.4.FIGO stage,degree of pathological tissue differentiation,growth pattern,tumor integrity,volume of ascites,satisfaction with debulking surgery,chemotherapy resistance,preoperative serum CA125,CA199,and CA724 values are related risk factors affecting prognosis and recurrence(P<0.05).The FIGO stage is an independent risk factor affecting the overall recurrence of patients.Patients with FIGO stage II-IV had a 16.466-fold higher risk of recurrence than those with stage I(OR=16.466,95%CI=3.458-78.398).Through the survival analysis of patients who have been followed up for more than five years,it is found that FIGO stage,degree of pathological tissue differentiation,lymph node clearance,ascites volume,ascites cytology,satisfaction with debulking surgery,chemotherapy resistance,tumor integrity,and serum CA125,CA724,and postmenopausal Rome index were potential risk factors affecting the survival outcome of patients(P<0.05).Satisfaction with debulking surgery and volume of ascites were independent risk factors affecting the survival outcome of patients(P<0.05).5.The incidence of lymph node metastasis in MOC was low(4.91%,3/61),and the postoperative pathological type was infiltrating in 2 cases(66.67%,2/3).Whether or not lymph nodes were removed in stage I patients did not affect the overall prognosis of patients(P=0.516).6.Appendectomy did not affect the five-year survival rate of patients(P=0.345),but 6.90%(4/58)of appendices with normal appearance still showed metastasis after postoperative pathology.7.Whether the reproductive function is preserved or not does not affect the prognosis of patients,and the overall survival time of patients with the two surgical methods is close(P=0.603).8.Different surgical methods,surgical routes,and chemotherapy did not affect the pregnancy outcome of patients with fertility requirements(P=0.483,P=0.891,P=0.718).9.Whether or not staged surgery was performed in early stage patients did not affect the overall patient prognosis(P=0.513),but positive lesions(2 cases,14.29%)could be found when some restaging operations(14cases in total)were performed,and the prognosis was poorer when the stage was improved.10.Postoperative chemotherapy or not in stage I patients did not affect the overall prognosis(P=0.105).However,among patients without chemotherapy,the postoperative recurrence rate of patients with stage IC was 3.81 times that of patients with stage IA and IB.Among patients receiving chemotherapy,the postoperative recurrence rate of patients with stage IC was 1.35 times that of patients with stage IA and IB.Conclusion: Ⅰ.Modeling data: 1.Age,tumor location,stage,number of lymph node dissection and tumor size are independent factors affecting the overall survival of MOC patients.2.Through the establishment of the model,a simple and practical prediction model is provided for clinicians,which is helpful for gynecologic oncologists to evaluate the individual situation of such patients and choose the appropriate treatment plan after operation,so as to achieve precision medicine.II.External validation data: 1.MOC occurs mostly in middle-aged women,and most patients seek medical treatment with abdominal pain or abdominal distension as the main complaint.The prognosis of early patients is good,and the prognosis of advanced patients is poor.The possible reason is related to the high incidence of chemotherapy platinum resistance.Expansive MOC is mostly early stage with good prognosis,while infiltrating MOC is mostly late stage(stage II-IV)with poor prognosis.Elevated values of CA125 and CA724 may be related to poor prognosis of patients.2.For patients with early MOC,Lymph nodes and appendix that are not abnormal in imaging or intraoperative examination may not be removed,but should be carefully investigated.Intraoperative resection of the appendix while sending frozen pathology may improve the accuracy of frozen pathology of ovarian tumors.For patients with postoperative pathology showing infiltrative type,systemic lymphadenectomy should be performed additionally.Satisfaction with debulking surgery is an independent risk factor affecting the prognosis of patients.For the first operation,the whole abdomen should be explored as much as possible to complete satisfactory debulking surgery.Patients who failed to complete the comprehensive staging operation in the initial operation due to various reasons should complete a comprehensive exploration and staging operation before initial chemotherapy.Satisfactory postoperative chemotherapy can improve the prognosis of patients.Patients with stage IA and IB MOC can be closely followed up after operation,but patients with high-risk factors of MOC stage IC and above stage II should receive standard postoperative chemotherapy.3.It is recommended that patients undergoing fertility-preserving surgery be required to complete staged fertility-preserving surgery as much as possible if conditions permit,and be closely followed up.Postoperative chemotherapy for patients with fertility preservation should minimize the course of treatment on the basis of controllable disease,and at the same time,try to choose drugs with low reproductive toxicity and little impact on ovarian function.4.The Nomogram model constructed by the research can be in good agreement with the actual situation in terms of prediction performance,and can predict the overall survival of MOC patients more accurately. |
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