| Background:ovarian cancer is the third most common gynecologic malignancy,the incidence is below cervical cancer and uterine cancer in our country.Ovarian cancer prognosis is poorer, 5-year survival rate is between 30% and40%.Because this is mainly due to 60 ~ 70% of patients with ovarian cancer are diagnosed at an advanced stage,then it can not underwent optimal cytoreductive surgery, and 70 ~ 80% patients will experience disease recurrence after first-line chemotherapy. "NCCN guidelines "claimed that recurrence with diseases < 6 months is defined as drug-resistant recurrence, ≥6 months is regarded as drug-sensitive relapse."Response rates between drug-sensitive recurrent ovarian cancer and drug-resistant recurrence ovarian cancer are significantly different, and the difference of prognosis between them even more significant. Drug-resistant ovarian cancer receive subsequent line chemotherapy with a single non-platinum agent,and the response rates(RRs) are generally low,such as 19-27%,with a progression free survival of 3–4 months and a median survival under a year. Drug sensitive recurrent ovarian cancer will respond to further platinum-based chemotherapy with response rates ranging from 30% to 90%.The median survival of patients with platinum sensitive recurrent ovarian cancer is 2years. Therefor, for poor prognosis patients who with drug-resistant ovarian cancer,explore clinico-pathological factors that can predict the biological behavior to judge the prognosis of ovarian cancer in forepart is one of the research directions.Objective: To investigate the prediction of the multiple clinical and pathological factors for the different time to relapse of advanced epithelial ovarian cancer,and seekthe factor can early predict a drug resistant ovarian cancer, provide guidance for clinical treatment and judge prognosis.Methods:The clinical data of 111 epithelial ovarian carcinoma patients who had been treated in our hospital from January 2004 to December 2014 was collected,including patients ’ age at diagnosis, body mass index,platelet levels,baseline serum CA-125 levels,FIGO stage,whether underwent primary debulking surgery, whether CA125 turn negative after two cycle chemotherapy,histological type,histological grade,chemotherapy regimens, administration route, course of chemotherapy.All patients were followed-up at least 6 months after chemotherapy.According to the time of recurrence,patients was divided into great than or equal to 6 months and less than 6months(resistance group and sensitive group).The impact of those clinico-pathological parameters on different time to relapse was analyzed.All surgical patients were newly diagnosed with primary epithelial ovarian cancer, and hadn ’t underwent neoadjuvant chemotherapy.Besides, patients who have severe heart, brain, liver, kidney or other important organ failures, blood system diseases and severe basic diseases such as infection were excluded form the study.All data was statistically analyzed using SPSS17.0 software. Chi-square test examined the correlation between prognostic factors and drug-resistant recurrence. Logistic regression model was used to conduct multivariate analysis.Results: In 111 stage III, IV epithelial ovarian cancer patients,57 cases sensitive relapse, 54 patients with drug resistant recurrence.Univariate analysis revealed,drug-resistant recurrence rate for age>50 years group was significantly higher than age≤50 years group(55.7%,31.3%,respectively), for PLT > 300 x 109 / L at diagnosed group was significantly higher than normal group(61.4%, 35.2%, respectively), for FIGO stage IV group was higher than stage III group(65.8%, 39.7% respectively),for non-serous ovarian cancer group was higher than serous ovarian cancer group(62.3%, 36.2%, respectively), for CA125 was not negative after two cycle chemotherapy was obviously higher than turned negative group(63.8%, 32.1%,respectively), the difference were statistically significant. The difference indrug-resistant recurrence rate for the other clinico-pathological factors, such as BMI( for BMI≥23, BMI <23:50%, 46.9%, respectively), whether underwent primary debulking surgery( for did not receive primary debulking surgery, underwent primary debulking surgery : 49.2%, 48.0%, respectively),histological grade( for other group of histological grade, poorly differentiated group : 51.9%, 45.6%, respectively), course of chemotherapy( for < 6 cycles, >6 cycles : 57.5%, 43.7%, respectively), chemotherapy regimens( for included taxanes, didn’t include taxanes:51.9%, 40.6%, respectively),administration route(for the other administration route, intravenous chemotherapy group: 53.2%, 42.9%, respectively), baseline CA125( for > 680 u/ml, ≤ 680 u/ml:58.8%, 45.1%, respectively)were no statistically significant difference. In multivariate Logistic regression model analysis, the risk of drug-resistant relapse for patients with age>50 was 3.736 times of the age≤50 ones and 95% confidence interval was [1.376~10.147],P=0.010. The risk of drug-resistant relapse for patients with platelet >300×109/L was 3.243 times of the platelet≤ 300×109/L ones and 95%confidence interval was [1.327~7.921],P=0.010.The risk of drug-resistant relapse for patients with CA125 turn negative after 2 cycles chemotherapy was 0.367 times of not turn negative ones and 95% confidence interval was [0.156~0.862],P=0.021.Conclusion:1. Ovarian cancer patients who is older( age>50 years), with higher platelet(>300×109/L) and CA125 reduced at the lower rate are less likely to turn out drug-resistant relapse and poor prognosis in the short term. 2. Suggested, platelet count and whether CA125 turn negative rapidly are the independent predictors of the prognosis for drug-resistant relapse of stage III,IV EOC. FIGO stage,histological type are significant associate with drug-resistant recurrence of EOC, but not independent predictors. 3. To develop large sample prospective clinical trials on the factors,such as BMI, whether underwent primary debulking surgery, course of chemotherapy,chemotherapy regimens, administration route and baseline CA125, and the other clinico-pathological factors that may have clinical significance, but this study were not involved. |
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