| Objective:ExPlore the choice of the best treatment for advanced ePithelial ovarian malignancy.Methods:This study retrospectively analyzed 232 patients with stage III-IV epithelial ovarian cancer treated at the Yunnan Provincial Tumor Hospital between January 2015 and May 2017.The treatment options were combined by the associate senior-level gynecologist of Yunnan Provincial Tumor Hospital and above physicians.The gynecological examinations,tumor markers(CA-125,CA-153,CA-199,CEA,AFP,CA-724)and imaging studies were evaluated after the overall assessment,and divided into primary tumor cells according to different treatment methods.Primary debulking surgery PDS group(n=124)and neoadjuvant chemotherapy NACT combined with interval debulking surgery IDS group(n= 108)were routinely supplemented with chemotherapy By collecting patient’s age,pathological stage,pathological type,gynecological examination,preoperative tumor markers,first diagnosis and preoperative CT,preoperative B ultrasound,intraoperative exploration,neoadjuvant chemotherapy cycles,neoadjuvant chemotherapy,Surgical time,amount of postoperative hemorrhage,post-chemotherapy,post-chemotherapy condition,and prognosis were analyzed retrospectively to establish a preoperative prediction model for patients with advanced epithelial ovarian cancer to select individualized treatment.Good programs to improve patient outcomes and improve the quality of life of patients.Results:1.The collected data were from 232 patients with stage III-IV epithelial ovarian cancer in Yunnan Provincial Tumor Hospital from January 2015 to May 2017.Of these,124 were included in the PDS group and 108 were NACT-IDS groups.There was a statistically significant difference in age and pathological stage(P<0.05).The age of NACT-IDS group was greater than that of PDS group,and the pathological component of NACT-IDS group was worse than that of PDS group.2.According to the intraoperative conditions,patients’ intraoperative residuals were divided into two groups:R<1cm and R≥1cm.Comparing PDS group and NACT-IDS group,the results showed that there was statistical significance between the two groups(P=0.002).NACT-IDS Compared with PDS group,better cytoreductive surgery can be achieved;3.The statistical method used an independent sample rank sum test:the statistical analysis of the operation time,intraoperative blood loss and postoperative hospital stay required for the two groups of treatment showed that:P<0.05,the NACT-IDS group had shorter operative time than the PDS group.Less bleeding and shorter postoperative hospital stay;4.According to intraoperative conditions,patients’ intraoperative residuals were divided into three groups:R<1cm(A),1≤R<2cm(B),and R≥2cm(C).The preoperative chemotherapy cycles and intraoperative residuals in the NACT-IDS group were compared.Relationships,the results showed:P>0.05,the difference was not statistically significant;using Spearman rank correlation correlation showed:P>0.05,no correlation between the number of preoperative chemotherapy cycles and intraoperative residual;5.Using multiple independent sample rank sum tests,the admission and preoperative tumor markers CA-125 in 108 patients with NACT were compared.The results showed that:CA-125 C group of admission tumor markers compared with group A,P<0.05,The CA-125 value in group A was significantly higher than that in group C;the preoperative group C was compared with group A,P<0.05,and the CA-125 value in group C was significantly higher than that in group A.The difference was statistically significant.All the values were more than 0.05.There was no significant difference between the three groups.The PDS group had no significant difference between the three groups of preoperative CA-125 CA.6.According to the intraoperative conditions,patients’ intraoperative residuals were divided into two groups:R<1cm and R≥1cm.The ROC curve was used to investigate the predictive effect of CA-125 on the cytoreductive surgery of ideal tumors.Theresults showed that the critical point of CA-125 in the PDS group was 803.95,where the sensitivity is 0.619,the specificity is 0.557,the highest index is 0.176;the preoperative CA-125 critical point in the NACT-IDS group is 76.74,where the sensitivity is 0.848,the specificity is 0.440,and the highest index is the highest 0.288;According to the CT establishment of the predictive scoring system,it is concluded that the χ2 test shows that when the PDS is divided into 2 points,the NACT-IDS group is divided into 2-3 points,the P value is>0.05,and CT prediction is used.The ratio of ideal cytoreductive surgery was basically the same;the critical value predicted by ROC curve showed that the critical point of preoperative CT score in PDS group was 1.5 points,the sensitivity was 0.683,the specificity was 0.590,and the highest index was 0.273.In the NACT-IDS group,the critical point was 1.5 points,the sensitivity was 0.545,the specificity was 0.680,and the highest index was 0.225.The results showed that both groups could achieve preoperative tumor scores>1.5 points to achieve ideal tumor cell depletion.Feasibility of surgery;preoperative CA-125 and CT prediction scores The credibility of the system to predict surgical cases slightly lower;7.The relationship between the number of postoperative cycles of chemotherapy and prognosis:NACT group P=0.052,P>0.05,indicating that there is no correlation between the two,but the P value is close to the critical value;comparing the relationship between the number of cycles of chemotherapy and prognosis after PDS group P=0.000,P<0.0001,indicating that there is a correlation between the two,with the prolongation of progression-free survival(Progression Free Survival PES)along with the number of postoperative chemotherapy cycles;the postoperative chemotherapy cycle is divided into<3,4-The 6 and 7-8 cycles in the three groups were compared using the χ2 test.The results showed that the P values in the PDS group were all<0.05,and 7-8 cycles of chemotherapy performed the best prognosis;NACT groups<3 and 7-8 cycles were compared.<0.05,7-8 cycles of postoperative chemotherapy prognosis is better than ≤3 cycles,the other two sets of two when compared P>0.05,the difference was not statistically significant,but ≤3 and 4-6 two groups P = 0.060,close to the critical Values,the results show that:NACT group prognosis does not improve with the number of chemotherapy cycles;8.The total number of chemotherapy cycles in the NACT group was divided into three groups:<6,7-8,and>9.The results of the pairwise comparison showed that:between<6 and 7-8 groups,P=0.050,and the results showed 7-8 The prognosis of the chemotherapy group was better than that of the<6-way group;in the<6-way and>9-way groups,the results showed:P<0.05,the>9 group had a better prognosis than the ≤6 group;between the 7-8 and>9 groups:There was no statistical difference.The results showed that after a total chemotherapy course of>8 cycles,the prognosis did not improve with the extension of the number of cycles;9.The two-group table chi-square test was used to compare the recurrence of the two groups,P<0.05,indicating that the recurrence rate of the NACT-IDS group was higher than that of the PDS group.According to the follow-up results,the prognosis of the patients was divided into 1 tumor-free survival group and 2 tumor-bearing survival group.3 death group;4 lost follow-up group,among which NACT-IDS group results were:41(38.0%),25(23.1%),26(24.1%),4.16(14.8%);PDS group results were:60(48.4%),31(25.0%),21(16.9%),12(9.7%);Rank sum test using rank data,P = 0.049,P<0.05,statistically significant difference,PDS group prognosis is significantly better NACT-IDS group;10.According to the intraoperative residual status of the eye,residual lesions ≥1cm are mainly distributed(by how much):domes,renal veins,retroperitoneal lymph nodes,mesentery and other parts.Conclusion(s):1.PDS and NACT-IDS patients had statistically significant differences in pathological stage and age:NACT-IDS group was older than PDS group,and the pathological stage was later than PDS group.Both age and pathological stage were considered to affect the treatment plan and prognosis.factor;2.Compared with the PDS and NACT-IDS groups,the NACT-IDS group was superior to the PDS group in terms of surgical excision rate,intraoperative time,intraoperative blood loss,and postoperative hospital stay.3.There was no significant correlation between the preoperative chemotherapy cycle and intraoperative residual tumor size in the NACT-IDS group.4.The value of preoperative tumor markers CA-125 may be an influencing factor of ideal tumor cytoreduction surgery and chemosensitivity is the influencing factor of the surgical net cut rate;the use of ROC curve to predict the criticality worthy to conclude:PDS group CA-125<803.95 Preoperative CA-125<76.74 mmol/L in the mmol/L and NACT-IDS groups can be used to predict the likelihood of ideal cytoreductive surgery,but the confidence is slightly lower;preoperative CT prediction models are used to predict ideals The tumor cytoreductive surgery showed that:NACT-IDS group and PDS group can use preoperative CT score<1.5 points to predict the possibility of ideal cytoreductive surgery,but the credibility is slightly lower;5.PDS group had the best prognosis after 7-8 cycles of chemotherapy;NACT-IDS group had the best prognosis after 7-8 cycles of chemotherapy.6.Compared with PDS group,NACT-IDS group had higher recurrence rate,increased Mortality,and lower overall survival OS.In the PDS and NACT-IDS groups,the sites with residual lesions ≥1cm were mainly located at the dorsal and renal lymph nodes,mesentery,etc.Retrospective CT findings suggested that the lymph nodes at the level of the renal veins were fused together and closely related to the vessels.The CT findings of extensive chestnut planting of the dome and mesentery are less effective. |
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