Study Of The Efficacy Of Different Treatments For Platinum-sensitive Recurrent Ovarian Cancer

Objective: Through retrospective case analysis of 132 platinum-sensitive Recurrent Ovarian Cancer(PSROC)cases in the Affiliated Tumor Hospital of Guangxi Medical University,and the different clinical characteristics influence on overall survival(OS)in PSROC patients,explore the factors affecting the survival of PSROC patients and the impact of different treatment options on the prognosis of PSROC patients.Methods: Clinical data of 132 patients with PSROC were collected from existing electronic medical records in the Affiliated Tumor Hospital of Guangxi Medical University from July 2010 to August 2018.5,including age,FIGO stage,histophiologic type,platinum-free intervals(PFI),CA125 at the time of recurrence,recurrent lesions and ascites,to explore the influencing factors of the survival of patients with PSROC and to build a prognostic prediction model.132 patients with PSROC were grouped according to different treatments after recurrence.(1)According to whether secondary cytoreductive surgery(SCS,called secondary surgery)was performed,Secondary surgery group(n=56cases)and chemotherapy alone group(n=76 cases).(2)According to whether the resection was satisfactory after secondary surgery,residual tumor lesions ≤1cm group(n=39 cases),and residual tumor lesions > 1cm group(n=17 cases).(3)According to whether secondary neoadjuvant chemotherapy(SNACT)was received before the second operation,the patients were divided into two groups:SNACT + SCS group(n = 20 cases)and directly SCS group(n = 36 cases).(4)According to chemotherapy regimens,standard chemotherapy group containing cisplatin/carboplatin group(n=47 cases),cisplatin/carboplatin + Vascular Endothelial Growth Factor(VEGF)group(n=13 cases),Other platinum-based(oxaliplatin + nedaplatin + lobaplatin)chemotherapy group(72 cases).(5)According to the principle of pharmacokinetics,the number of treatment courses were divided into four groups: < 4 cycles group(n=54 cases),4-6 cycles group(n=60 cases),and > 6 cycles group(n=18.5 cases),respectively.Through RWS methods to explore the impact of different treatments on the prognosis of PSROC patients,OS is the main evaluation endpoint of the study.Results:(1)Cox univariate analysis showed that PFI,recurrent CA125,recurrent lesions and ascites were correlated with OS in PSROC patients(P<0.05).Age,FIGO stage and histopathological type were not associated with OS(P>0.05).These results indicated that PSROC patients with longer PFI,lower CA125 level at recurrence,isolated recurrent lesions and no ascites had better prognosis.(2)COX multifactor analysis showed that four factors that were significant in univariate analysis were included in the multifactor analysis,and PFI and recurrent lesions were found to be associated with OS in PSROC patients,indicating that the above two factors were independent risk factors for the prognosis of PSROC patients(P<0.05).(3)The results of the prognostic prediction model column line plot showed that the prognostic prediction model was constructed based on 2 factors that were meaningful for multifactorial analysis,PFI and recurrent lesions,and the column line plot was used to predict the probability of survival of PSROC patients at different times.(4)Among 132 PSROC patients,the follow-up time ranged from 2 to 108 months,with a median follow-up time of 33.5 months.Analysis of the primary endpoint showed that(1)median OS was 51.0 vs 29.0 months in the secondary surgery group and chemotherapy alone group,respectively(HR=0.45,95% CI0.27-0.77,P=0.0031),and median OS was prolonged by 22 months in the secondary surgery group,with a statistically significant difference(P<0.05).(2)The median OS was 55.0 vs 36.0 months in the tumor residual lesion <1 cm group and tumor residual lesion ≥1 cm group,respectively(HR=0.40,95% CI0.18-0.89,P=0.024),and the median OS was prolonged by 19 months in the tumor residual lesion <1 cm group,and the difference was statistically significant(P<0.05).(3)Median OS was 38.0 vs 56.0 months in the SNACT+SCS group and the direct SCS group,respectively(HR=2.02,95% CI0.95-4.29,P=0.066),with similar OS between the two groups.(4)Median OS was 49.0 vs 30.5 months in the cisplatin/carboplatin-based conventional chemotherapy group and the other platinum-based chemotherapy group,respectively(P<0.05).vs 30.5 months(HR=0.62,95% CI 0.41-0.95,P=0.029),with a statistically significant difference of 18.5 months in the conventional chemotherapy group(P<0.05).(5)The median OS was 35.0 vs 49.0 months in the cisplatin/carboplatin-based chemotherapy + vasopressor group and the cisplatin/carboplatin-based chemotherapy group,respectively(HR=1.52,95%CI 0.65-3.57,P=0.33),with similar OS in both treatment groups(P>0.05).(6)Median OS was 29.5 vs 42.0 vs 38.0 months in the treatment <4 course group,4-6 course group,and treatment >6 course group,respectively(HR=0.74,95%CI 0.41-1.34,P=0.053),with no statistically significant difference between the three groups(P>0.05).Conclusion: In patients with PSROC,satisfactory secondary surgery provides a significant survival benefit.For patients who cannot undergo direct secondary surgery,SNACT may not be an alternative treatment modality.Combination chemotherapy with cisplatin or carboplatin remains the treatment of choice for patients with PSROC.