| Part 1:The therapeutic effects of NACT in advanced epithelial ovarian cancerObjective:We aimed to evaluate the impact of neoadjuvant chemotherapy or primary debulking surgery on progession free survival and overall survival in patients with advanced epithelial ovarian cancer, and to investigate the value of neoadjuvant chemotherapy.Methods:Study population:115 patients treated in Southeast University Provincial Zhongda hospital and Jiangsu cancer hospital with stage IIIC or IV epithelial ovarian cancer from January 2005 to December 2012 were included.Methods:Patients were divided into NACT-IDS group (56 cases) and PDS group (59 cases) according to their primary treatment. Patients in NACT-IDS group were received 2 to 3 courses of platinum-based chemotherapy prior to interval debulking surgery.Patients in PDS group underwent initial debulking surgery, followed by some courses of adjuvant chemotherapy. The patients'general status, optimization degree of debulking surgery, intraoperative evaluation, chemotherapeutic effects and survival were all analyzed for comparison between two groups to investigate the value of neoadjuvant chemotherapy.Results:1.Of the 115 patients,56 were treated with NACT-IDS, and 59 were referred to PDS.There were no differences between the groups in regard to age, BMI, Clinical symptoms, stage, tumor histology, tumor histological grade (P> 0.05).2.The average operative time and blood loss in NACT-IDS group were 222.86min,487.5mL, and in PDS group were 260.42min,763.6mL,the difference in two groups were statistically significant (P<0.05). The satisfied rate of complete resection of all macroscopic disease in two groups were 66.1% and 45.8%, which was statistically significant (P<0.05).3. The total clinical effective rate in NACT-IDS group was 76.8% (43/56), in PDS group was 52.5%(31/59), the difference between two groups was statistically significant (P<0.05).4. The mortality rate in NACT-IDS group and the PDS group were 39.3% (22/56),54.2%(32/59), respectively(P>0.05). The 1-year survival in NACT-IDS group and PDS group were 96.4% (54/56) and 94.9%(32/59), respectively(P> 0.05).The 2-year survival in two groups were 85.7%(48/56) and 79.7%(47/59), respectively(P>0.05).The 3-year survival were 80.0%(45/56) and 71.2%(37/52), respectively(P>0.05).The 5-year survival were 45.8%(11/24) and 48.4%(15/31), respectively(P>0.05). The PFS in NACT-IDS group and PDS group was similar,at 19.8(5.2-42.3) months and 19.2(4.0-90.5) months, respectively(P>0.05).The OS in two groups were 47.3(6.8-115.6) and 46.7(9.1-115.2) months, no differences was found in two groups(P> 0.05). Conclusion:We found that survival on the treatment of neoadjuvant chemotherapy followed by interval debulking surgery and primary debulking surgery was similar, but NACT can improve operative conditions, increase optimal cytoreductive rate, less blood loss, shorter operative time and increase the clinical effective rate of treatment compared with patients with PDS. Part 2:The influence factors for clinical prognosis in advanced epithelial ovarian cancerObjective:To explore the factors which maybe associated with the prognosis of advanced epithelial ovarian cancer, such as age, BMI, co-morbidity, tumor histological grade> tumor histology, residual tumor and postoperative adjuvant chemotherapy.Methods:115 patients with advanced epithelial ovarian cancer were enrolled, age, BMI, co-morbidity, tumor histological grade, tumor histology, residual tumor and postoperative adjuvant chemotherapy were analyzed to investigate the association with the prognosis of advanced epithelial ovarian cancer.Results:1.Univariate analysis:Of the 115 patients with advanced epithelial ovarian cancer,85 patients were divided with serous carcinoma, the average OS was 43.9 months, the 3-year survival was 71.8%(56/78), the 5-year survival was 36.1%(13/36).30 patients were divided with non-serous carcinoma, the average OS was 55.4 months, the 3-year survival was 86.7%(26/30), the 5-year survival was 68.4%(13/19), respectively(P> 0.05). For 65 patients with residual tumor<1cm,50 patients with residual tumo?1cm,where average OS in two groups were 54.8 and 36.8 months, respectively(P<0.05), the 3-year survival were 93.5%(58/62) and 52.2%(24/46), the 5-year survival was 71.0%(22/31) and 16.7%(4/24), respectively(.P<0.05). After surgery there are 90 patients who received six or more than six courses of adjuvant chemotherapy,while 25 patients received less than six courses, the average OS were 50.9 months and 30.0 months, the 3-year survival were 84.3%(70/83) and 48.0%(12/25), the 5-year survival were 52.1%(25/48) and 14.3%(1/7), the differences in survival were statistically significan(P<0.05). The tumor histology, residual tumor and postoperative adjuvant chemotherapy were associated with the prognosis of advanced epithelial ovarian cancer, while the age, BMI, co-morbidity and tumor histological grade were no statistically significance in prognosis.2.Multivariate analysis:Tumor histology, residual tumor and courses of postoperative adjuvant chemotherapy were independent risk factors which effect theprognosis of advanced epithelial ovarian cancer. The hazard ration in patients with serous carcinoma and non-serous carcinoma was 2.165, in patients whose residual tumor<1cm and?1cm was 0.21, in patients who recevied?6 courses of adjuvant chemotherapy and<6 courses the risk of death was 0.479.Conclusion:In patients with advanced epithelial ovarian cancer,the serous carcinoma, the size of residual tumor?1cm and the courses of adjuvant chemotherapy<6 were independent risk factors of prognosis, therefor the residual tumor size was the most important prognostic factor. |
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