| Research backgroundCurrently epithelial ovarian cancer is still the main cause of death in women with gynecological malignancies.Without typical clinical manifestations early and specific screening tool,about 70%patients have been diagnosed with advanced stage,resulting in higher mortality.NCCN guidelines proposed the primary choice of treatment for the epithelial ovarian cancer is initial cytoreductive surgery,namely the satisfaction of cytoreductive surgery and postoperative adjuvant chemotherapy given to platinum-based chemotherapy in combination with paclitaxel.However,for advanced epithelial ovarian cancer,the patients have occurred within the abdominal cavity or extensive metastasis,and poor general condition of most patients at this time,more complications.They often have difficult to tolerate major surgery to achieve complete resection of all macroscopic clinical visible lesions.Neoadjuvant chemotherapy refers to chemotherapy or early after diagnosis of ovarian cancer,select the appropriate effective chemotherapy regimen administered to the patient a limited course of chemotherapy,then re cytoreductive surgery.Most ovarian cancers are sensitive to cytotoxic chemotherapy drugs,and more than 80%of patients are sensitive to the paclitaxel plus platinum-based chemotherapy.Neoadjuvant chemotherapy can reduce tumor burden,chest surgery and ascites water,thereby reducing the extent of surgery reduce the incidence of perioperative complications.However,theory suggests that neoadjuvant chemotherapy did not improve relapse-free survival and overall survival,but also led to the occurrence of drug resistance,in particular resistance mechanism is unclear.In this study,it was a retrospective analysis of case studies to further explore neoadjuvant chemotherapy-related research and advanced epithelial ovarian cancer platinum drug resistance,and its relationship with the secondary resistance recurrent epithelial ovarian cancer were research and forth,whice provided guidance and basis for clinical treatment.Research method1?We select those patients who were diagnosed with epithelial ovarian cancer,fallopian tube cancer,or primary peritoneal cancer hospitalized in the PLA General Hospital between 01 January 2005 to 01 January 2015,besides,were diagnosed ?c period or ?after surgery according to the latest FIGO(2013)surgical-pathologic staging.There were two groups including NACT-IDS group(neoadjuvant chemotherapy with interval debulking surgery group)and PDS group(primary debulking surgery group),by the patients were follow-up and compared between the reaction of platinum(including platinum-sensitive and platinum-resistant)and relapse-free survival whether there are differences,in order to evaluate neoadjuvant chemotherapy is associated with advanced epithelial carcinoma platinum resistance.2?We select the first part of this study enrolled patients with relapse of epithelial ovarian cancer,fallopian tube cancer,or primary peritoneal cancer patients,and patients with recurrence of diagnosis and treatment and follow-up in our hospital are completed,treatment information is complete.There were two groups including NACT-IDS group(neoadjuvant chemotherapy with interval debulking surgery group)and PDS group(primary debulking surgery group),then these two groups were compared between the reaction of platinum(including platinum-sensitive platinum-resistant)and relapse-free survival if there were differences,at the same time,further analysis of the high-grade and low-grade serous ovarian carcinoma recurrent differences in relapse-free survival period,to assess whether neoadjuvant chemotherapy and secondary relapse epithelial ovarian cancer drug resistance and its effect on different tissues grade serous cancer drug resistance.Research results1?Neoadjuvant chemotherapy did not increase platinum-resistant with advanced epithelial ovarian cancer,at the same time,primary cytoreductive surgery group had no significant difference in the impact on relapse-free survival.Cytoreductive surgery residual tumor size can affect the relapse-free survival,residual lesions>1cm will shorten the time to relapse-free survival,multivariate COX regression analysis showed that the residual tumor size is a single risk factor for recurrence-free survival.2?Neoadjuvant chemotherapy increased the resistance to platinum of secondary recurrent epithelial ovarian cancer,but there was no significant difference in the relapse-free survival of platinum-sensitive recurrent ovarian cancer,multivariate COX regression analysis showed that neoadjuvant chemotherapy and age affect the secondary recurrent epithelial ovarian cancer relapse-free survival,and they were the two independent risk factors.Through the analysis results of the two different levels of serous ovarian cancer(high grade and low grade),neoadjuvant chemotherapy can reduced relapse-free survival of the high-grade serous cancer recurrence,but does not shorten recurrence-free survival of the recurrent low-grade serous ovarian cancer. |
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