| Background and Objective:Ovarian cancer is the leading cause of gynecologic cancer-related mortality in the world.Surgical cytoreduction is the cornerstone of current treatment in patients with advanced disease,but it offers the best chances for overall survival when optimal cytoreduction is achieved.The objective of the study was to identify the factors on influencing the optimal debulking rate of primary cytoreductive surgery for advanced epithelial ovarian cancer(AEOC), and to study the influencing factors of morbidity and mortality after cytoreduction, and to analyse the prognostic factors and survival of AEOC.Materials and Methods:Part one: 206 patients with FIGO stage III or IV advanced epithelial ovarian cancer were included from the First Affiliated Hospital of Fujian Medical University and Fujian Provincial Tumor Hospital between January 2000 and October 2010 in the study. This part retrospectively accessed the factors that influencing the optimal debulking rate of primary cytoreductive surgery for AEOC, when we defined"optimal debulking"as leaving residual disease of less than 1 centimeter in maximum tumor diameter.Part two: The postoperative complication morbidity and mortality of the patients that underwent primary cytoreductive surgery in the Part One were retrospectively analyzed, and the influencing factors of complications were explored by univariate and multivariate analysis methods. The independent influencing factors were identified by Binary logistic regression.The postoperative complicative rate was predictived by nomograph medol.Part three: The clinic and follow-up materials of 206 patients with AEOC in Part One were collected and analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factor were identified by COX proportional Hazard regression medol, and the overall survival were compared by Kaplan-Meier curve. Results:Part One: 112 of 206 patient with AEOC completed the optimal cytoreductive surgery, occupied 54.37%, when 94 patients received suboptimal debulk. The factors that including preoperative serum CA125,the volum of ascites, bilateral ovarian invasion, mesenteric invasion, omental cake and epigastric invasion were identified as the significant influencing indicators for postoperative complications by univariate analysis, and the factors that including preoperative serum CA125, bilateral ovarian invasion, mesenteric invasion and epigastric invasion were comfirmed as the independent influencing indicators by multivariate analysis.Part Two: 54 of 206 patient with AEOC who underwent cytoreduction experienced postoperative complication morbidity, and the complication rate was 26.21%. The influencing factors that including preoperative clinic indicators(age, performance status index(PSI), medicine comorbidity),preopetarive serum indicators(preoperative blood hemoglobin,serum albumin, fibrinogen, preoperative CA125 level),postoperative indcators(surgical complexity scores(SCS), operative time , the volum of transfusion) were identified as the significant influencing indicators, when the factors that including age(hazard ratio(HR)=1.071),PSI(HR=4.928), preoperative blood hemoglobin(HR=1.370),serum albumin(HR=1.6508), fibrinogen(HR=8.843), preoperative CA125(HR=1.001), SCS(HR=4.476), operative time(HR=1.040) were comfirmed as the independent influencing indicators by binary logistic regression, and the more significant influencing indicators is PSI,preoperative serum albumin,fibrinogen, SCS based on HR value.The predictive postoperative complication morbidity by nomograph medol was 27.49% while the actual morbidity was 26.21%,and there was no significant difference between them.Part three: 5-year overall survival rate of 206 patients with AEOC in Part One was 35.9%, 103 patients died up to the follow-up deadline date, and median survival time was 38 months. Age, menopause,preoperative serum CA125,performance status index, residual disease, postoperative morbidity, bilateral ovarian invasion,omental cake and 6 cycles postoperative chemotherapy were identified as the influencing prognostic factors by univariate analysis, and the parameters that including performance status index(HR=1.680),residual disease(HR=3.922), postoperative morbidity(HR=1.862) and 6 cycles postoperative chemotherapy(HR=2.045) were confirmed as the independent prognostic factors by multivariate COX regression. Conclusions:(1)Preoperative serum CA125, bilateral ovarian invasion, epigastric invasion and mesenteric invasion are the independent influencing factors of optimal debulking rate of primary cytoredutive surgery for AEOC, and are considered as the predictive factors of optimal debulking.(2)Performance status index, preoperative serum albumin, serum fibrinogen and surgical complexity scores are the independent influencing factors of postoperative morbidity after primary cytoreductive surgery for AEOC.(3)Nomogram model is considered as a useful tool to predict the postoperative complication morbidity after PCS for AEOC in clinic practice, but it needs further confirmation in additional ramdomised clinical trials in the future.(4) Performance status index, residual disease ,postoperative complication morbidity and 6 cycles postoperative chemotherapy are the independent prognostic factors for AEOC.(5)The admisson's hospital are not identified as the influencing factors for optimal debulking, postoperative morbidity and prognosis for AEOC in this study if the patients are admitted into a gerenal provicial Grade A hospital for treatment.
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