European Journal of Biomedical and Pharmaceutical Sciences

INFLUENCE TO CHOOSE TREATMENT METHODS ON PROGNOSIS OF RECURRENT OVARIAN CARCINOMA

Dr. Nita Yadav* and Dr. Qu Peng Peng

ABSTRACT

Objective: The main purpose of this study was to evaluate the prognosis of patients with recurrent epithelial ovarian cancer in the Tianjin Obstetrics and Gynecology Hospital in Tianjin; to evaluate the difference in the efficacy of secondary cytoreductive surgery or chemotherapy alone in patients with recurrent epithelial ovarian cancer; The difference in quality of life between the two treatment regimens after treatment. Methods: The hospital records for patient with ovarian carcinoma of Tianjin Central hospital of Obstetrics and Gynecology was reviewed prospectively from February 2017 to March 2019 which included patients age, presenting complaint, associated symptoms if any, duration of disease, clinical features, menstrual history, details of physical examination, results of imaging studies if any, results of office biopsy if performed, operative procedure, and pathology diagnosis from the surgical specimen. The serum levels of CA125(IU/ml), HE4(Pmol/ml) were investigated from initial presentation of disease and during the treatment course and have also been recorded and reported. Two groups are formed for comparison, group A is recurrent cases who received surgery and group B recurrent cases receiving chemotherapy alone. There are 20 patients in group A and 17 patients of group B. The diagnosis of epithelial ovarian carcinoma was entirely based on the histopathology and immunohistochemistry. All the data were analyzed by SPSS 22.0 statistical software. A comparative analysis of two groups compared using chi square test was done. The difference of P <0.05 was statistically significant. Results: A prospective observational study was performed on 40 patients with recurrent epithelial ovarian cancer who were admitted to the Tianjin Obstetrics and Gynecology Hospital from February 2017 to March 2019. Of the 40 patients, 11 were stage I of epithelial ovarian cancer, 4 were stage II of epithelial ovarian cancer, 22 were stage III of epithelial ovarian cancer, and 1 case was stage IV of epithelial ovarian cancer. Among them, 12 patients were younger than or equal to 50 years old, and 25 patients were older than 50 years old. In the initial treatment, 35 patients underwent initial cytoreductive surgery, and 2 patients underwent neoadjuvant chemotherapy; 24 patients underwent lymph node resection in the initial treatment and 13 patients did not have lymph node resection. In the 37 patients with recurrent epithelial ovarian cancer, in the second treatment, considering the patient's wishes, the current state of the body and the progress of the disease, 20 patients underwent secondary cytoreductive surgery, and 17 patients underwent chemotherapy alone. Univariate analysis of complete remission rate was associated with treatment (secondary cytoreductive surgery or chemotherapy alone), P = 0.011, OR = 8. Related to the CT value, P=0.018. With the first surgical procedure (initial cytoreductive surgery or neoadjuvant chemotherapy), age (≤50 years or older), whether lymph nodes were removed during initial treatment, patients were in stage of epithelial ovarian cancer (I II III IV Period), CA125 and HE4 values are irrelevant. Multivariate analysis of CT values and OR values of treatment methods, CT = OR = 2.431 (95% CI 1.12 - 5.289), (P = 0.025); OR of treatment mode was 8.391, and the lower limit of 95% confidence interval was 1.194. The upper limit of the 95% confidence interval is 58.969 (P = 0.03). In the 20 patients with secondary cytoreductive surgery, the median disease-free progression (PFS) was 30 (95% CI 21.5-38.5) months, and the simple chemotherapy-free 17 patients had a median disease-free progression (PFS) of 11 patients. (95% CI 8.4-13.6). Conclusion: In this study, we obtained statistically significant differences in the efficacy of secondary cytoreductive surgery or chemotherapy alone in patients with recurrent epithelial ovarian cancer. In order to improve the quality of life of patients with recurrent epithelial ovarian cancer, the physical condition of the patient,It is advisable to take secondary cytoreductive surgery for patients with recurrent epithelial ovarian cancer. In some patients with epithelial ovarian cancer after primary surgery and a platinum-sensitive recurrent tumor, complete resection of the recurrent tumor during secondary cytoreductive surgery improves progression-free survival and overall survival. Our results suggest that a long treatment-free interval and non-disseminated lesions (three or fewer lesions) on radiographic images could be useful predictors of complete resection during secondary cytoreductive surgery.

Keywords: Secondary cytoreductive surgery epithelial ovarian cancer no visible residuals progression-free survival and treatment-free interval platinumsensitive.