ABSTRACT
Objective To explore the clinical effect of neoadjuvant chemotherapy combined with tumor cell subtraction in the treatment of advanced epithelial ovarian cancer,as well as the effects on serum epididymal secretory protein 4 ( Human Epididymis protein 4,HE4) ,and glucose polypeptide antigen 125 ( cancer antigen 125,CA125 ) . Methods From January 2010 to January 2014, patients with advanced ovarian cancer from Quanzhou First Hospital Affiliated to Fujian Medical University were selected. According to the difference of clinical treatment plan,128 patients with advanced epithelial ovarian cancer were divided into the observation group ( 68 cases ) and the control group ( 60 cases ) . The patients in the observation group were given neoadjuvant chemotherapy combined with tumor cytoreductivesurgery, and the control group was treated with tumor cytoreductivesurgery and conventional chemotherapy. The clinical efficacy, operation time, blood loss volume, ascites volume, complication, hospitalization time, HE4and CA125 were compared between the two groups. Also 1 year,3 year survival rate,HE4 and CA125 levels of the two groups were analyzed. Results The number of satisfactory tumor reduction cases in observation group was significantly higher than that in control group( 73. 53％( 50/68) ,51. 67％( 31/60) ,χ2=6. 56,P<0. 05) . The short-term effect of observation group was significantly better than that in control group( Z=5. 79,P<0. 05) . The operation time,blood loss volume,ascites volume,complication and hospitalization time of observation group were significantly lower than those in control group (operation time:(119. 6±39. 1) min vs. (177. 3±45. 6) min,t=7. 71,P<0. 05;blood loss:(378. 9 ±88.4) ml vs. (616.3±110.8) ml,t=13.47,P<0.05;ascites volume:(678.5±205.1) ml vs. (1372.4 ±405. 8) ml,t=12. 42, P<0. 05;complication: 13. 2％( 9/68) vs. 31. 7％( 19/60),χ2 = 6. 34, P<0. 05;hospitalization time:(10. 4±3. 2)d vs. (15. 3±3. 1)d,t=8. 77,P<0. 05). There was no significant difference in HE4 and CA125 between the two groups before treatment ( P>0. 05) . After chemotherapy,the level of HE4 and CA125 decreased significantly in the two groups after chemotherapy,and the observation group was significantly lower than the control group (HE4: (98. 3±28. 9) pmol/L vs. (153. 2±44. 1) pmol/L,t=8. 42,P<0. 05;CA125:(35. 3±14. 8) vs. (48. 3±14. 2) ) kU/L,t=5. 05,P<0. 05). The myelosuppression and digestive tract reaction in the observation group were more serious than those in control group (χ2=4. 09,4. 87,P<0. 05) . There was no significant difference in the 1 year survival rate between the two groups ( 86. 76％ vs. 81. 67％,χ2=0. 63, P>0. 05 ) . After 1 years of follow-up, the levels of HE4 and CAl25 in the observation group were significantly lower than those in the control group (HE4:(112. 2±33. 7) pmol/L vs. (189. 4±39. 6) pmol/L,t=10. 95,P<0. 05;CA125:(51. 2±14. 2) kU/L vs. (59. 7±18. 6) kU/L,t=2. 69,P<0. 05). 3 year survival rate in observation group was significantly higher than that in control group ( 55. 88％ vs. 38. 33％,χ2 =3. 94, P<0. 05). The levels of HE4 and CAl25 were significantly lower than those in control group(HE4:(166. 5±45. 5) pmol/L vs. (245. 7±51. 8) pmol/L,t=6. 25,P<0. 05;CA125:(77. 4±18. 5) kU/L vs. (94. 4±16. 7) kU/L,t=3. 61,P<0. 05) . Conclusion Neoadjuvant chemotherapy combined with cytoreductive surgery can effectively improve the clinical efficiency and improve the prognosis of patients with advanced epithelial ovarian cancer.