Multifactorial Impact On The Outcome Of Interval Debulking Surgery And Prognosis In Patients With Advanced Epithelial Ovarian Cancer

Objective:To analyze the impact factors of interval debulking surgery(IDS)and survival in patients with advanced epithelial ovarian cancer(AEOC),and to provide a suggestion for the timing of IDS.Methods: Patients with stage III/IV EOC,peritoneal or fallopian tube cancers diagnosed at the First Affiliated Hospital of Chongqing Medical University from June 2013 to July 2018 and undergoing NACT-IDS were enrolled.The Clinical pathological data were retrospectively extracted from patients' records.Preoperative body mass index(BMI),number of NACT,serum human epididymis protein 4(HE4),Carbohydrate antigen 125(CA125)and cytokeratin 19 fragment(CYFRA21-1)were analyzed for the correlation with IDS surgical outcome and survival.Results: NACT cycles and preoperative BMI had no effect on IDS outcome and patients' survival(P>0.05).Serum HE4 at diagnosis,preoperative CA125 and CA125 decline after NACT,and preoperative CYFRA21-1 level can all affect the outcome of IDS(P<0.05);the area under the ROC curve was 0.67,0.73,0.69,0.70,0.69,respectively.Among them,preoperative HE4 is the best predictor for optimal cytoreduction,with a positive predictive value of 84% and a negative predictive value of66%,and the level higher than 184pmol/L is an independent factor of optimal IDS.Survival analysis seemed to support the association ofpreoperative serum CYFRA21-1?3ng/ml with shorter PFS,while with no statistic significance(P=0.078).The level of initial HE4?484pmol /L,preoperative HE4?184pmol/L,CA125?155U/mL,the decrease of CA125 after NACT<96% and suboptimal cytoreductive surgery were proved to an indicator of poor progressive-free survival of patients(P<0.05);however,initial serum HE4?484pmol /L and the diameter of maximum residual tumor greater than 1cm were independent risk factors for PFS.In addition,patients with initial serum HE4?484 pmol/L,pre-IDS CA125?155U/mL and suboptimal cytoreduction had shorter OS(P<0.05),but multivariate analysis presented that HE4 was the only independent risk factor for patients' OS(P=0.020).Conclusion: Serum HE4 level in patients with advanced EOC is superior to serum CA125 in evaluating the outcome of IDS and patients' PFS.When preoperative serum HE4 is lower than 184pmol/L,IDS has a high possibility of optimal cytoreduction.The initial HE4 level higher than484 pmol/L and suboptimal IDS were highly correlated with poor PFS.The level of CYFRA21-1 in EOC might be an indicator for IDS surgical outcomes and PFS,which is worthy of further study.