| Objective: Analyze the clinical characteristics and prognostic factors of patients with epithelial ovarian cancer(EOC)to provide a basis for future clinical treatment of EOC.Methods: Collected the complete data of 1047 EOC patients in the Department of Gynecology,the Fourth Hospital of Hebei Medical University from February 1,2009 to September 30,2015,including the age of illness,ascites,and the International Federation of Gynecology(FIGO)staging,neoadjuvant chemotherapy(NACT),lymph node resection,size of residual lesions(R0: no residual disease to the naked eye,R1: residual disease ≤1cm,R>1: residual disease>1cm),pathological type,Tumor grade and chemotherapy status,etc.and according to whether NACT is performed,it is divided into primary debulking surgery(PDS)and interval debulking surgery(IDS),review the above data Sexual analysis.Use SPSS 26.0 statistical software,propensity score matching for cohort study,use Kaplan-Meier method to calculate overall survival(OS),progression-free survival(PFS)and survival rate and draw survival curve,Cox Stepwise regression was performed for multivariate prognostic analysis,and P<0.05 is statistically significant.Results:1.Overall survival and disease progression: As of September 30,2015,485 patients had died,the 5-year overall survival rate was 52.7%;There were633 recurrence,and the 1-year,2-year,3-year,and 5-year progression free survival rates were 74.8%,55.0%,45.6%,and 38.5%,respectively.2.The 5-year overall survival rates of patients with early EOC(stages I,II)and advanced EOC(stages III,IV)were 87.5%,36.8%,respectively,and the 5-year progression free survival rates were 76.5%,21.1%,respectively.3.EOC was mainly in advanced stage patients,a total of 719 patients(68.7%),including 600 patients in the primary debulking surgery(PDS)group,119 patients in the interval debulking surgery(IDS)group,and the choice of NACT + IDs was mainly based on CT evaluation of lesion extent and ascites.Compared with PDS,he proportion of stage IV in the NACT+IDS group is more(22.7% vs 6.3%,P<0.001),the proportion of reaching R0 is higher(47.9% vs 37.7%,P=0.037),and there are more residual lesions It is located in the liver,spleen,top of the diaphragm and the surface of the mesentery.The 5-year overall survival rates were 38.3% and 29.1% in the PDS group and NACT + IDS group(P=0.062),and the median overall survival was41 and 32 months,respectively;The 5-year progression free survival rates were 22.7% versus 13.8%(P=0.024),and the median progression-free survival was 16 versus 20 months,respectively.4.The proportion of lymph node removal in EOC patients was significantly higher in early stage patients than in late stage patients(P<0.001).Propensity score matching was performed on the influence of lymph node resection on the prognosis of early and late stage patients.Before matching,247 patients who received chemotherapy after early EOC surgery were included in the study.Among them,82 patients in the unresected lymph node group,There were 165 patients in the systemic lymph node resection group.The 5-year overall survival rates were 80.8% and 89.6%(P=0.054),and the5-year progression-free survival rates were 65.6% and 81.0%(P=0.007).There were 120 patients after matching.(60 cases in the unresected group and60 cases in the SL group)were included in the study.The 5-year overall survival rates were 81.3% and 89.9%(P=0.163),and the 5-year progression-free survival rates were 66.1% and 81.7%(P=0.048).696 patients with advanced EOC were included in the study.There were 513 patients in the unresected lymph node group and 183 patients in the systemic lymph node resection group.The 5-year overall survival rates were 31.6% and 52.0%,respectively(P<0.001).The median overall survival of the unresected group was 36 months and 5 years.The progression-free survival rates were 15.7%and 37.1%(P<0.001),and the median progression-free survival was 18 and 32 months,respectively.After matching,a total of 366 patients(183 in the unresected group and 183 in the systemic lymph node resection group)were included in the study,5 years overall survival rates were 40.3% and 52.0%(P=0.077),the median overall survival of the unresected group was 48 months,the 5-year progression-free survival rates were 18.3%,37.1%(P=0.002),and the median progression-free survival was 24 and 32 months.5.Advanced patients: 108 cases of lymph node enlargement were assessed by preoperative imaging and/or intraoperative,including 41 cases in the unresected group,9 cases in the unsystemic lymph node resection group,58 cases in the systemic lymph node resection group,5-year overall survival rates were 24.5%,33.3%,and 61.7%,respectively(P=0.01).The median-year of the unresected group and the unsystemic lymph node resection group were32 and 21 months,respectively;the 5-year progression-free survival rate was12.2%,22.2%,47.8%(P<0.001),the median progression-free survival was 19,20,and 57 months,respectively.There were 166 cases with no lymphadenopathy in the assessment,including 24 cases in the unresected group,12 cases in the unsystemic lymph node resection group,and 130 cases in the SL group.The 5-year overall survival rates were 43.9%,23.6%,48.7%(P=0.315),and the median overall survival They were 45,35,and 57 months;the 5-year progression-free survival rates were 43.9%,23.6%,48.7%(P=0.221),and the median progression-free survival was 15,12,and 24 months,respectively.6.Univariate analysis of age,CA125 at the time of initial treatment,ascites volume,ascites cytology,lymph node resection,residual lesion size,pathological type,degree of tissue differentiation,FIGO staging,tumor cytoreductive surgery,and chemotherapy course are all beneficial to the patient to a certain extent overall survival and progression-free survival have an impact(P<0.05).Chemotherapy and lymph node metastasis had no significant effect on the prognosis of patients(P>0.05).7.Multivariate analysis showed that ascites volume,FIGO staging,postoperative residual lesion size,degree of tissue differentiation,lymph node resection and chemotherapy course were independent prognostic factors affecting overall survival in EOC patients(P<0.05).Multivariate analysis showed that ascites volume,ascites cytology,FIGO staging,postoperative residual lesion size,degree of tissue differentiation,lymph node resection and chemotherapy course were independent prognostic factors affecting progression-free survival in EOC patients(P<0.05).Conclusions:1.The 5-year overall survival rate of EOC patients undergoing surgical treatment in the Fourth Hospital of Hebei Medical University was 52.7%,and the 5-year progression-free survival rate was 38.5%.2.Compared with PDS,NACT+IDS can increase the satisfactory rate of tumor cytoreduction in advanced EOC,and can delay the progression of the disease,but has no effect on the overall survival rate;for advanced patients,individualized selection is required,and appropriate patients are selected for NACT.3.Through propensity score matching,it is found that for patients with early EOC who are supplemented by chemotherapy after surgery and patients with advanced EOC,compared with patients with unresected lymph nodes,Systemic lymph node resection can delay disease progression and has no significant effect on overall survival.4.Whether EOC patients undergo lymph node resection still needs to be comprehensively evaluated in combination with clinical practice.If there are suspicious enlarged lymph nodes in preoperative imaging and/or intraoperative evaluation,Systemic lymph node resection is recommended.If the evaluation is negative,lymph nodes do not need to be removed.5.The ascites volume,FIGO stage,postoperative residual lesion size,degree of tissue differentiation,lymph node resection and chemotherapy course are independent prognostic factors that affect overall survival and progression-free survival in EOC patients.Ascites cytology is an independent prognostic factor affecting progression-free survival in EOC patients. |
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