| Background and ObjectiveOvarian cancer is a high-grade gynecologic malignancy.The 5-year survival rate is low,and the early symptoms are not obvious.Most of the ovarian cancers are diagnosed as advanced-stage and advanced ovarian cancers.Some of them have lost the opportunity of operation,infiltration metastasis is early,and some patients are resistant to chemotherapy.The main treatment for ovarian cancer is primary debulking surgery(PDS)+ postoperative platinum chemotherapy,for patients with advanced ovarian cancer,especially those with large abdominal mass and loss of surgical time,neoadjuvant chemotherapy(NACT)can be performed before surgery,reduce tumor size and improve resection rate.The application of neoadjuvant chemotherapy is still a problem that needs to be studied now,and it is looking forward to a more standardized and individualized treatment plan.At present,the molecular mechanism leading to the biological behavior of ovarian cancer is not yet clear,but the malignant proliferation of cells is a key step in the malignant biological behavior of most cancer cells.In order to find out the molecular biological mechanism of ovarian cancer and launch targeted therapy,researchers have done a lot of research.A large number of studies have shown that this cell marker Ki-67 is closely related to the malignant biological behavior of tumors,and Ki-67 is a marker that can identify benign and malignant tumor tissue,and can be used to determine the degree of malignancy and biomarkers of prognosis.Recent studies have found that CD40 molecules expressed on the surface of B cells,thymic epithelial cells,activated monocytes/macrophages,dendritic cells,etc.are also expressed on the surface of epithelial tumor cells.Therefore,the subject of the current neoadjuvant chemotherapy after intermittent cytoreductive surgery,and no neoadjuvant chemotherapy for the initial tumor cytoreductive surgery,by immunohistochemical methods to detect two groups after the line NACT and non-NACT advanced epithelial ovarian cancer.Tissue expression levels of CD40 and Ki-67 molecules,to judge the effect of neoadjuvant chemotherapy on the expression of CD40 in advanced epithelial ovarian cancer,and to further infer whether the CD40 molecule can be used as a biomarker for the prediction of chemotherapy sensitivity in ovarian cancer.Materials and methods 1.MaterialsThe study subjects were 80 patients with advanced epithelial ovarian cancer surgically obtained from the Second Affiliated Hospital of Zhengzhou University from December 2015 to December 2017.Among them,30 patients with neoadjuvant chemotherapy were group A;50 cases of reduction surgery,group B.Both groups received routine chemotherapy after surgery.Corresponding paraffin cut 80 pieces.2.MethodsCollect general information of all subjects: age,CA125 level,radiological findings,electrocardiogram and biochemical routine.According to neoadjuvant chemotherapy and intermittent debulking surgery IDS,30 patients in group A and 50 patients undergoing direct cytoreductive surgery in group B,and ideal cytoreductive surgery for both groups.Follow-up of 24 months in both groups.All histopathological specimens were obtained by surgery.The pathological diagnosis included 21 cases of serous ovarian cancer in group A,5 cases of mucinous ovarian cancer,and 4 cases of other types of ovarian cancer,aged 44-73 years,median age 56 years;50 cases in group B,38 cases of serous ovarian cancer,7 cases of mucinous ovarian cancer,5 cases of other types of ovarian cancer,aged 41-69 years,median age 56 years.At the same time,effective paraffin specimens were selected for sectioning,dewaxing and antigen retrieval.Immunohistochemistry was used to detect the expression of CD40 and Ki-67 in ovarian cancer tissues.Results1.Clinical efficacy of neoadjuvant chemotherapy in Advanced epithelial ovarian cancerAmong the 30 patients with neoadjuvant chemotherapy combined with intermittent cytoreductive surgery for advanced epithelial ovarian cancer,they received 1-2 courses of neoadjuvant chemotherapy.Thirty patients were effective for NACT.The total effective rate of chemotherapy was 80.0%(24/30).Among them,there were 4 cases of complete remission(CR),ie,all lesions disappeared,and CA125 ≤ 35 U/ml;partial remission(PR)was 20 cases;stable or no change(SD)was 6 cases;no progress was reported.Twenty-nine of the patients who underwent initial cytoreductive surgery were effective,and the total effective rate was 58%.A group was significantly lower than group B,the difference was statistically significant(χ2=4.059,P<0.05).2.The expression of CD40 and Ki-67 in NACT and non-NACT patients with Advanced Epithelial Ovarian Cancer(1)The positive expression rates of CD40 in neoadjuvant chemotherapy and non-NACT patients were 56.67% and 74.0%,respectively.The difference was statistically significant(P<0.05).(2)The positive expression rates of Ki-67 in neoadjuvant chemotherapy and non-NACT were 60.0% and 72.0%,respectively.The difference was statistically significant(P<0.05).3.The expression of different clinical efficacy of CD40 and Ki-67 in neoadjuvant chemotherapy(1)The positive rates of CD40 in clinically effective and ineffective patients were 45.83% and 100.00%,respectively,and those who responded to chemotherapy were significantly lower than those without chemotherapy.The difference was statistically significant(P<0.05).(2)The positive rate of Ki-67 was 41.67% and 83.33% in neoadjuvant chemotherapy,and the effective rate of chemotherapy was higher than that of chemotherapy failure,but the difference was not statistically significant(P>0.05).4.The Expression of CD40 and Ki-67 in Different Tissue Types of Advanced Epithelial Ovarian Cancer(1)The positive expression rates of serous,mucinous and other types of CD40 in neoadjuvant chemotherapy were 61.90%,60.00%,and 25.55% in intermediate and advanced epithelial ovarian cancer,respectively,and the difference was not statistically significant(P>0.05);Ki-The positive expression rates of 67 were 57.14%,40.00%,and 25.55%,with no significant difference(P>0.05).(2)The positive rates of serous,mucinous,and other types of CD40 in patients without neoadjuvant chemotherapy were 81.58%,71.43%,and 80.00%,respectively;there was no significant difference(P>0.05);the positive rate of Ki-67 expression 78.95%,51.14%,80.00%,the difference was not statistically significant(P> 0.05).5.Expression of CD40 is positively correlated with Ki-67 in advanced ovarian cancer.Conclusion1.Significant difference in expression of CD40 and Ki-67 in neoadjuvant chemotherapy and non-neoadjuvant chemotherapy in patients with advanced epithelial ovarian cancer.The lower the expression of Ki-67 and CD40 after neoadjuvant chemotherapy,the higher the sensitivity to chemotherapy and the better the effect of chemotherapy.2.CD40 can be used as a biomarker for predicting the sensitivity of neoadjuvant chemotherapy.The CD40 test can help guide the development of treatment regimens for advanced epithelial ovarian cancer. |
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