Association Between Dynamic Changes Of NLR,PLR And CA125 And The Prognosis Of Patients With Epithelial Ovarian Cancer

Part 1Objective:Ovarian cancer has the highest mortality rate in gynecologic malignancies,and about 75%of patients are diagnosed at advanced stage(FIGO IIb-IV)at the initial diagnosis.Among them,epithelial ovarian carcinoma is the most common,accounting for about 85%-90%of ovarian cancer and mostly occurs at the age between 50-60.It has been reported that the longer the clinical complete remission is,the longer the survival time will be.Therefore,how to predict PFS early and correctly for patients with complete clinical remission(CCR)after standardized treatment is helpful to clinical stratification and ultimately to improve the prognosis.Previous studies have focused only on NLR,PLR,and CA125 levels in patients with epithelial ovarian cancer before treatment,and there have been few reports on the association between postoperative NLR,PLR,and CA125 and prognosis in patients with epithelial ovarian cancer.NLR,PLR,and CA125 are a dynamic process of change.Retrospective studies were conducted to explore the relationship between NLR,PLR and CA125 changes and prognosis of ovarian cancer patients.Method:Clinical data of ovarian cancer patients who underwent treatment at Zhongda Hospital,School of Medicine,Southeast University and Jiangsu Cancer Hospital,Nanjing Medical University,were collected from January 2012 to June 2017.The patients of the study group were screened from the collected cases with complete clinical features and follow-up data.Data analysis was performed using SPSS 24.0 statistical software with Progression free survival as outcome measure.Receiver operating characteristic(ROC)curve method was used to determine the critical value of preoperative NLR and preoperative PLR.Kaplan-Meier method was used to analyze relationship between preoperative and postoperative NLR,PLR and CA125 levels-;CA125 half-life,CA125 negative time,CA125 levels before and after the third cycle of chemotherapy,age,FIGO staging,pathological type,histological grade,tumor thrombus and ascitic fluid,and progression free survival(P<0.05).The survival curves were compared by Log-Rank test.Based on the results of single factor analysis,the COX model was used for multifactor analysis to analyze independent risk factors affecting the progression free survival of ovarian cancer patients.Results:A total of 195 patients who met the inclusion criteria had complete clinical data and follow-up records,and 117 patients developed disease progression.Single factor analysis showed:Progression-free survival of the patients with epithelial ovarian cancer was associated with histological grade,tumor thrombsisin the lymphatic vessels,FIGO staging,CA125 half-life,CA125 negative time and preoperative NLR levels(P<0.05).Multivariate analysis by the COX model showed:tumor thrombsis in the lymphatic vessels,CA125 half-life,histological grade and preoperative NLR levels are the independent risk factors for progression-free survival in the patients with epithelial ovarian cancerConclusion:The half-life of CA125 is an indicator of the dynamic changes of serumCA125,which may provide a reference value for evaluating PFS in patients with epithelial ovarian cancer.Preoperative NLR level has great value in the evaluation of PFS in patients with epithelial ovarian cancer,but the dynamic changes in perioperative NLR and PLR to assess the clinical value of PFS in ovarian cancer patients require more large-sample,multicenter studies or prospective study.Part 2Objective:To evaluate the diagnostic value of serum cancer antigen 125(CA125)in recurrent ovarian carcinoma patients by pooling the open published studies using meta-analysis method.Methods:Two independent reviewers searched the PubMed and Web of Science database for diagnosis of serum CA125 in patients with recurrent ovarian cancer..The sensitivity,specificity,positive likelihood ratio(PLR),negative likelihood ratio(NLR)and diagnostic dominance ratio(DOR)were analyzed with Med DiScl.4 software,and the area under the receiver operating characteristic curve(AUC)and publication bias in the curve were analyzed by Stata14.0 software.Results:16 studies finally fulfilled the inclusion criteria and were included in this meta-analysis.The pooled sensitivity,specificity,PLR,NLR,DOC were 0.66(95%CI:0.63 to 0.69),0.86(95%CI:0.83 to 0.89),5.56(95%CI:2.64 to 11.71),0.41(95%CI:0.31 to 0.55),and 15.08(95%CI:6.06 to 37.51)obtained by random effect model.The pooled ROC was 0.85(95%CI:0.81 to 0.95).No publication bias was found(P = 0.026).Conclusion:serum CA125 for detection of recurrent ovarian carcinoma showed lower sensitivity and higher specificity and it can be used as a supplementary test.