Study On The Neoadjuvant Chemotherapy In Epithelial Ovarian Cancer

Objectives: To investigate the feasibility of neoadjuvant chemotherapy (NAC) applied on patients with unresectable epithelial ovarian cancer (EOC). To verify the prognostic influencing factors in NAC group. We examined the connection between the prognosis in EOC and expression of P-gp, MRP (multidrug resistance-associated protein) and TopoIIa.Methods: Retrospective analysis was carried out on 56 patients with unresectable ovarian, tubal and peritoneal cancer and treated with platinum-based NAC. Their clinical outcomes were compared with those of 16 advanced EOC patients with an amount of ascite which is greater than 500ml, but treated with primary cytoreduction followed by platinum-based chemotherapy. Immunohistochemcial analysis was performed based on 20 EOC patients before and after NAC.Results: The progression free survival (PFS) and overall survival (OS) does not show any significantly statistical difference between the NAC group and the conventional group (median PFS: 19 vs. 30 months;median OS: 39 vs. 48 months). The parameters of surgical aggressiveness (operation time, blood loss, blood transfusion) were significant lower than those in NAC. The number of resection of small intestine or colon and the extension of tumor into spleen, porta hepatis, gallbaddler or hepatic surface was low in NAC (10.87% vs. 43.75%). The size of largest tumor mass outside ovarian was small in NAC group (5.5 vs. 11.3cm). The Cox multivariate analysis showed that only the course of the treatment and the size of largest tumor mass after NAC were the independent risk factors in the prognosis of the NAC group. Those patients with CA125 half-life of less than 28 days have longer progression free survival time than those with longer CA125 half-life. The expression of P-gp and MRP after NAC shows nosignificant difference while the expression of TopoIIa was lower than its expression before NAC. The expression decreases in 8 out of 22 patients. The progression free survival time between patients TopoIIa expression decreased and increased shows no significant difference. The median progression free survival time of both P-gp negative and TopoIIa high expression (++ and +++) before NAC is longer than others (27 vs. 9 months).Conclusions: The NAC did not appear to worsen the prognosis and, in contrast, it permits a less aggressive surgery to be performed. For the lower rate of bowel surgery, the quality of patients' life is improved after NAC. Only the course of the treatment and the size of largest tumor mass after NAC were the independent risk factors in the prognosis of the NAC group. The CA125 half-life of 28 days can discriminate the prognosis between "good" or "poor". 1-2 courses of NAC did not show the significant resistance to the drug. Patients with both P-gp negative and TopoIIa high expression had poor prognosis, which limited the performance of NAC.