| Objective: To analyze the effect of different metastasis paths on prognosis of stage Ⅲ High-Grade Serous Ovarian Cancer.Methods: Retrospective case data study.Patients with stage Ⅲ high-grade serous ovarian cancer who were admitted to the Affiliated Hospital of Qingdao University from 2000 to2020 and met the inclusion criteria were counted.According to the metastasis path,patients were divided into two groups: simple lymph node metastasis group and peritoneal metastasis group(With or without lymph node metastasis group).Chi-square test and Wilcoxon rank-sum test were used to analyze the relationship between clinical characteristics,chemotherapy sensitivity,recurrence rate,recurrence site,expression of chemokine receptor CCR7 and different metastatic paths of patients.Kaplan-meier survival analysis curve and COX proportional risk regression model were used to perform survival analysis,and discuss the factors affecting prognosis of patients.Results: 1.According to inclusion and exclusion criteria,535 patients with FIGO stag Ⅲ HGSOC were finally included,including 481 patients(89.91%)in the peritoneal metastasis group and 54 patients(10.09%)in the simple lymph node metastasis group.There was no significant difference in age of onset between the two groups(58.80±8.86&58.50±9.27,P>0.05).The median initial CA125 level before treatment in the peritoneal metastasis group was 878.151U/m L,and that in the lymph node metastasis group was 581.00U/m L,that is,the initial CA125 level in the lymph node metastasis group was lower than that in the peritoneal metastasis group.The difference was statistically significant(P=0.014).The initial HE4 level before treatment in the lymph node metastasis group(198.90U/m L)was lower than that in the peritoneal metastasis group(512.80U/m L),the difference between the two groups was statistically significant(P=0.000).In the peritoneal metastasis group,the rate of neoadjuvant chemotherapy(NACT)was 60.08%,and in the lymph node metastasis group,the rate of NACT was 29.63%.There were significant differences in the rate of NACT between the two groups(P< 0.05).There was no significant difference in surgical satisfaction and chemotherapy times among patients with different metastasis paths(P>0.05).2.Comparing the sensitivity of chemotherapy among different metastasis paths,the sensitivity rate of chemotherapy in the lymph node metastasis group(86.79%)was higher than that in the peritoneal metastasis group(74.22%),and the difference between the two groups was statistically significant(P=0.038).The recurrence rate of peritoneal metastasis group was 56.75%.That rate of lymph node metastasis group was 37.03%,and the difference between the two groups was significant(P=0.004).3.Comparing the different recurrence sites of ovarian cancer patients with two different metastasis paths,the peritoneal recurrence rate was 60.87% and the lymph node recurrence rate was 5.22% in the peritoneal metastasis group,the peritoneal recurrence rate was 35.29%and the lymph node recurrence rate was 11.76% in the lymph node metastasis group.The peritoneal recurrence rate in the peritoneal metastasis group was higher than that in the lymph node metastasis group,and the difference between the two groups was significant.The rate of lymph node recurrence in the lymph node metastasis group was higher than that in the peritoneal metastasis group,and the difference was not statistically significant.4.Immunohistochemical semi-quantitative method was used to compare the expression rate of CCR7 between the different metastasis paths.The mean optical density of lymph node metastasis group(0.259±0.077)was higher than that of peritoneal metastasis group(0.196±0.023),and the difference was statistically significant(P< 0.05),that is,the average response intensity of CCR7 positive cells in the lymph node metastasis group was higher than that in the peritoneal metastasis group.Moreover,the ratio,density and H-score of CCR7 positive cells in the lymph node metastasis group were higher than those in the peritoneal metastasis group,indicating that the expression level of CCR7 in lymph node metastasis tissues was higher than that in peritoneal metastasis tissues.5.Kaplan-meier survival analysis curve was used to estimate the difference between progression-free survival and overall survival with different metastasis paths(P< 0.05).The PFS of the lymph node metastasis group was 55.9%,which was higher than that of the peritoneal metastasis group(26.5%).The OS of the lymph node metastasis group was 48.9%,higher than that of the peritoneal metastasis group(11.8%).The 5-year OS of the only lymph node metastasis group was 56.5%,and that of the peritoneal metastasis group was 33.6%,with no significant difference(P=0.089),but the 5-year OS of the group with only lymph node metastasis was higher than that of the group with peritoneal metastasis.6.Univariate COX proportional risk regression analysis was performed for each clinicopathological factor to screen factors whose P<0.05,and analyzed them by multivariate COX proportional risk regression model.The initial HE4 level and chemotherapy sensitivity were found to be independent factors affecting the prognosis of stage Ⅲ HGSOC.Compared with chemotherapy-resistant patients,chemotherapy-sensitive patients had a better prognosis,and compared with patients with higher initial HE4 level,patients with lower initial HE4 level had a better prognosis.Conclusions: 1.Compared with the peritoneal metastasis group,HGSOC patients with lymph node metastasis alone had lower initial CA125 and HE4 levels,which were more sensitive to chemotherapy and had a lower recurrence rate.2.Chemokine receptor CCR7 is highly expressed in lymph node metastasis tissues of HGSOC patients with lymph node metastasis,which is associated with lymph node metastasis and lymph node recurrence.3.The PFS and OS of HGSOC patients with lymph node metastasis alone were higher than those with peritoneal metastasis,and the prognosis was better.4.Initial HE4 level and chemotherapy sensitivity were independent factors affecting the prognosis of stage Ⅲ HGSOC,lower initial HE4 level(<587.9U/ m L)had better prognosis. |
