Efficacy of neoadjuvant chemotherapy combined with interval debulking surgery on patients with stage III high grade papillary serous ovarian cancer and its impact on quality of life

Abstract

Objective To investigate the efficacy of neoadjuvant chemotherapy combined with interval debulking surgery (NACT-IDS) on patients with stage Ⅲ high grade papillary serous ovarian cancer and its impact on quality of life. Methods A total of 304 patients with advanced ovarian cancer (FIGO Ⅲ) were selected, of which 168 patients underwent neoadjuvant chemotherapy+ surgery+ chemotherapy (study group), 136 patients underwent primary debulking surgery+ chemotherapy (control group). Operation time, intraoperative blood loss, ideal reduction rate, rate of intraoperative blood transfusion, rate of pelvic abdominal infection, clinical efficacy, laparoscopic surgery rate, recurrence rate and survival rate of the two groups were compared to assess the therapeutic effect. Results The average level of preoperative carbohydrate antigen 125 (CA125) was 2 531 U/ml in study group and 1 431 U/ml in control group, the difference was statistically significant (P<0.05). The ideal reduction rate was 89.3% in study group and 77.9% in control group, the difference was statistically significant (P=0.007). The blood loss, operation time and recurrence rate in study group (235.09 ml, 207.38 min, 4.8%) were lower than those in control group (788.68 ml, 241.47 min, 27.2%), all P<0.05. The rates of laparoscopic surgery in study group (95.84%) was higher than that in control group (53.68%)and blood transfusion rate of study group (4.8%) was lower than that of control group (27.2%), both P<0.05. The mean progression-free survival (PFS) of study group and control group was 23.200 (6.100-38.000) months and 20.868 (4.000-33.000) months, respectively, and there was a significant difference between the two groups in PFS (P=0.046). The overall survival (OS) of study group was 37.596 (11.000-60.000) months and that was 35.053 (6.000-54.000) months of control group, the difference was not statistically significant (P=0.113). The average cost was 89 700 RMB in study group and 100 400 RMB in control group, the difference was statistically significant (P<0.05). The 1-year and 3-year survival rates were 92.26% and 72.61% in study group and were 88.23% and 52.94% in control group. Psychological impact of different treatments: 53 cases (31.5%) may have depression, 96 cases (57.1%) definitely had depression, 12 cases (7.2%) had sever depression in study group; in the control group, 47 cases (34.6%) may have depression, 64 cases (47.1%) definitely had depression, 16 cases (11.7%) had severe depression; there was no significant difference in the number of people who had depression or worse between the two groups (P=0.235). Conclusions NACT-IDS in the treatment of advanced ovarian cancer can significantly improve the surgical resection rate of tumor, reduce intraoperative blood loss, shorten the operation time, reduce the rate of laparotomy, incidence of surgical complications, tumor recurrence rate and improve the clinical effect. Key words: High grade papillary serous ovarian cancer; Neoadjuvant chemotherapy; Intermittent tumor cell subtraction