| Objective:To explore the dynamic changes of CA125 and HE4 during neoadjuvant chemotherapy(NACT)to determine the critical values for predicting satisfactory tumor cell depletion after intermittent tumor ablation surgery(IDS)during NACT.At the same time,the relationship between the level of complications after IDS and preoperative serum albumin was analyzed to determine an appropriate threshold to reduce the occurrence of high postoperative complications.Methods:Retrospective analysis of patients with advanced ovarian cancer who received NACT-IDS treatment mode in Department of Gynecology,Shanxi Hospital,Cancer Hospital,Chinese Academy of Sciences from January 2017 to October 2022.Collect clinical data,obtain demographic data,levels of CA125 and HE4 after each NACT,as well as levels of CA125 and HE4 before IDS,preoperative serum albumin levels,postoperative pathology,NACT frequency,and postoperative complications.Calculate the dynamic changes of CA125 and HE4,draw receiver operating characteristic curve(ROC)of subjects,and calculate the critical values of CA125 and HE4 that enable patients to achieve satisfactory tumor cell reduction.Simultaneously analyze the relationship between preoperative serum albumin and postoperative complications,draw the ROC curve of preoperative serum albumin in the low complication group,and determine the appropriate critical value.Results:1.The single factor analysis results of CA125 and HE4 showed that the P values of CA125(U/m L)after the first NACT and CA125(U/m L)before IDS were 0.024 and0.022,respectively,with a statistically significant difference(P<0.05);After the third NACT,the P value of HE4(pmol/L)was 0.023,with a statistically significant difference(P<0.05).2.When factors with P<0.05 in CA125 and HE4 single factors were included in multivariate regression analysis,it was found that the P value of CA125(U/m L)before IDS was 0.026,and the difference was still statistically significant(P<0.05);After the third NACT,the P value of HE4(pmol/L)was 0.037,with a statistically significant difference(P<0.05).3.According to ROC curve analysis,CA125 levels before IDS predicted a higher AUC for satisfactory tumor reduction surgery compared to CA125 levels after the first NACT(AUC=0.725,P=0.024).The critical value of CA125 is 23.56U/m L.At this time,the sensitivity was 90.90%,and the specificity was 51.3%.4.According to the ROC curve analysis,after the third NACT,HE4 predicted a higher AUC for satisfactory tumor cell depletion,with an area under the curve of AUC=0.74(95% CI 0.574-0.906),and a critical value of HE4 of 53.78p/mo L.At this point,the sensitivity is 60% and the specificity is 80%.5.Through the analysis of the sensitivity and specificity of CA125 combined with HE4,the sensitivity and specificity of the combined detection of CA125 and HE4 are higher than those of the single combined detection,with a sensitivity of 96.36% and a specificity of 90.26%.6.The postoperative complications of 50 patients were grouped according to the CDC classification,of which 11 patients had high complications after IDS surgery,while the remaining patients did not have high complications.Divide them into two groups and conduct a normality test.It is found that the data of the two groups follow a normal distribution.Then,conduct two independent sample T-tests on them,and obtain a T-value of-2.131,a P-value of 0.038(P<0.05),with a statistically significant difference.The ROC curve was plotted for the low complication group,and the critical value was43.3g/L.Conclusion:For patients with advanced epithelial ovarian cancer,CA125 ≤ 23.56U/m L combined with HE4 ≤ 53.78pmol/L is the critical value for predicting satisfactory tumor cell depletion,and the combined detection of the two is more effective(sensitivity96.36%,specificity 90.26%).Preoperative serum albumin≤43.3g/L is a critical value for predicting high postoperative complications. |
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