Analysis of prognostic-related risk factors in ovarian clear cell carcinoma

Analysis of prognostic-related risk factors in ovarian clear cell carcinoma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Analysis of prognostic-related risk factors in ovarian clear cell carcinoma Xingyun Xie, Yuting wei, Wenjuan Chen, Rongrong Wu, Chenying Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4637467/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To analyze the clinical characteristics of patients with ovarian clear cell carcinoma and to explore the prognostic-related risk factors. Methods We retrospectively analyzed 102 patients diagnosed with ovarian clear cell carcinoma (OCCC) in Fujian Cancer Hospital from January 2007 to December 2018. Progression-free survival time (PFS) and overall survival time (OS) were estimated by Kaplan-Meier curve, and Cox proportional hazards regression analysis were summarized for the clinical outcomes. Results The median follow-up time of 102 patients was 89.62 months. The 5-year overall survival (OS) and progression-free survival (PFS) were 59.2% and 50.0%. Cox regression univariate analysis showed that stages, concurrent endometriosis, chemotherapy, standardized treatment, platinum chemoresistance, CA-125 normalization, the last CA125 ≤ 20U/ml, and venous thrombosis were associated with OS and PFS ( P <0.05). The lymph node status was only related to OS ( P <0.05). Multivariate analysis showed that stage (HR = 3.475, 95%CI: 1.559–7.744, P = 0.002), standardized treatment (HR = 0.298, 95%CI༚0.137–0.648, P = 0.002) and platinum resistance (HR = 9.325, 95%CI༚4.076–21.334, P< 0.001) were independent prognostic factors for OS. Standard treatment (HR = 0.347, 95%CI༚0.161–0.750, P = 0.007) and platinum resistance (HR = 62.709, 95%CI༚18.687-210.431, P< 0.001) were independent prognostic factors for PFS. Conclusion Stage ,platinum resistance and platinum-based chemotherapy are important prognostic factors in patients with ovarian clear cell carcinoma. CA125 levels ,endometriosis, lymph node status and venous thrombosis are also associated with prognosis. Biological sciences/Cancer/Cancer therapy Biological sciences/Cancer/Gynaecological cancer Ovarian cancer clear cell carcinoma clinical features risk factors prognosis Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Ovarian cancer (ovarian cancer, OC) is one of the three major gynecological malignant tumors, with high malignancy, insidious onset, and higher fatality rate than other gynecological malignancies. Epithelial ovarian cancer (epithelial ovarian cancer, EOC) accounts for about 90% of ovarian cancer.Among them, ovarian clear cell carcinoma (OCCC) accounts for about 6% [1,2] . Compared with other ovarian cancers, ovarian clear cell carcinoma has unique biological characteristics histologically and prognoses [3] . The onset of OCCCs, with obvious ethnic and geographical differences [4] . In Asia, the incidence rate is the highest in Japan, accounting for 15%~25% [5] . In China, OCCC accounted for 9.7% of all EOCs according to the study by Wang S et al [6] .The median age of ovarian clear cell carcinoma was 55 years versus 64 years for ovarian serous carcinoma [7] .About 90% of patients had a tumorconfined to unilateral ovarian, but only 19–22% bilaterally [8,9] . Although most OCCC can be detected in the early stage, The treatment of OCCC is standard staging surgery or tumor cytoreduction as far as possible.someadvanced patients undergo intermediate tumor cytoreduction after neoadjuvant chemotherapy.Most of the patients received platinum-based chemotherapy regimens as the postoperative first-line treatment.it still has a high tendency of recurrence after chemotherapy [10] . OCCC has related prognostic risk factors, such as demographic characteristics, stage, combined endometriosis (endometriosis, EMs), molecular features, surgical methods, postoperative tumor residual, adjuvant therapy, and combined venous thrombosis (venous thromboembolism, VTE). There has been little progress in the treatment of OCCC in the last ten years.So in this study, the clinical characteristics, survival and prognosis of 102 patients were reviewed to explore the prognostic factors related to treatment. MATERIAL AND METHODS Patients A total of 102 patients diagnosed as ovarian clear cell carcinoma were collected from January 2007 to December 2018. Detailed clinical data were collected by consulting medical records and clinical follow-up data, including age, menstrual status, complaint symptoms, CA125 level, FIGO stage, tumor size and side, operation type, preoperative or intraoperative tumor rupture, ascites, stage, presence of endometriosis (ovarian and / or outside ovary), efficacy evaluation and recurrence. The following conditions were met: (1) histologically confirmed pure-OCCC type. (2) surgery was performed in Fujian cancer hospital. (3) standard treatment was completed. (4) postoperative follow-up was standardized and completed. All included patients have provided written informed consent to use their clinical data. The study was approved by the Ethics Committee of Fujian Cancer Hospital (Ethical approval number:K2023-045-01). We confirmed that all methods were performed in accordance with the relevant guidelines and regulations. Follow-up Chemotherapeutic resistance was defined as definite tumor progression or recurrence within six months from the last chemotherapy. Postoperative survival data were obtained through outpatient or telephone follow-up, and the final follow-up period was in March 2022. In cases where there was no follow-up information in the past six months, patients were classified as lost to follow-up. Survival analysis included overall survival (OS) and disease-free survival (DFS). OS was defined as the time from the first operation to death or last follow-up. DFS was defined as the time from initial surgical treatment to the occurrence of tumor progression/recurrence. Statistical Analysis Statistical analysis was performed using Statistical Package for Social Science (SPSS)statistical software (Version 25.0, SPSSInc, Ch icago, Ill) and multivariate COX regression analysis was used to analyze the clinical prognosis. P < 0.05 was considered statistically significant. Risk factors with a P < 0.10 were selected for inclusion in multivariate COX regression analysis, and the difference was considered statistically significant. RESULTS Clinical and pathological characteristics A total of 102 cases of ovarian clear cell carcinoma were included, among which 64 cases were at stageⅠ(62.1%), 18 cases at stage Ⅱ(17.6%), 16 cases at stage Ⅲ (15.7%), and 4 cases at stage Ⅳ (3.9%). The age ranged from 31 to 72 years old (49.40 ± 7.94) with a median age of 49 years old. Among them, 65 cases (63.7%) presented with abdominal mass, 22 cases (21.5%) with abdominal pain, 8 cases (7.8%) with abdominal distension, and 2 cases (1.9%) with postmenopausal vaginal bleeding. One case was complicated with endometrial carcinoma at stage Ia, while the other 5 cases (4.8%) were due to menstrual disorder (2 cases), frequent urination (2 cases), and dysuria (1 case). Among the 102 ovarian clear cell carcinomas, 6 (6.0%) were complicated with other malignancies. 40 patients (39.2%) with endometriosis. All patients received first-line chemotherapy with a mean of 5.38 ± 2.51 cycles.34 (36.2%) showed resistance. Forty-three patients (42.7%) experienced recurrence, and 38 patients (88.3%) caused deaths, accounting for 86.4% of the total number of deaths in this study. The overall survival time was (60.67 ± 39.04) months, and the median survival time was 52.84 months. Disease-free progression survival time was (52.63 ± 42.43) months and the median survival time was 45.10 months.(Table 1 ) Table 1. Clinical characteristics and survival of patients Project Number Percentage Age <50 52 52.0 ≥50 50 49.0 Principal complaint Lower abdominal pain 22 21.5 Pelvic mass 65 63.7 Abdominal distention 8 7.8 Menstrual disorder 2 1.9 Irregular vaginal bleeding 2 1.9 Sychnuria 2 1.9 Dysuria 1 0.9 Complicated with endometriosis No 62 60.8 Yes 40 39.2 Intraovarian endometriosis 15 14.7 Adenomyosis 20 19.6 Both 5 4.9 Side of tumor Unilateral 95 93.1 Both sides 7 6.9 Stage Ⅰ 64 62.7 Ⅱ 18 17.6 Ⅲ 16 15.7 Ⅳ 4 3.9 Operation Yes 100 98.0 No 2 2.0 Chemotherapy Yes 95 93.1 TP 94 90.2 EP 3 2.9 No 7 6.9 Platinum chemoresistance Yes 34 36.2 No 60 63.8 Chemotherapy cycles <3 19 18.6 ≥3 83 81.4 Recurrence or metastasis Yes 43 42.2 No 59 57.8 Venous thrombosis Yes 9 8.8 No 93 91.2 Survival state Survived 58 56.9 Died 44 43.1 Abbreviations: TP, Paclitaxel plus platinum; EP, Etoposidel plus platinum. Survival analysis All 102 patients were followed for more than 3 years, with a median follow-up time of 89.62 months (range from 40.1 to 182.7 months). The median OS of the patients was 52.84 months, and the PFS was 45.10 months. The 3-year, 5-year and 10-year OS rates were 71.6%, 59.2% and 44.4%, respectively; the 3-year, 5-year and 10-year PFS rates were 56.9%, 50.0% and 38.9%, respectively. The comparison of OS rates and PFS rates between early (I~Ⅱ) and late (Ⅲ~Ⅵ) patients is shown in Figure 1. The median OS and PFS of early patients did not reach the end point, and the median OS and PFS of advanced patients were 20.84 months and 10.45 months, respectively, showing a statistically significant difference (P <0.001).(Figure 1) Analysis of the total survival time of 102 patients Univariate analysis of the COX risk regression model showed that overall survival time (OS) was associated with stages, concurrent endometriosis, chemotherapy, Initial lymph node metastasis, platinum chemoresistance, CA-125 normalization, the last CA125≤20U/ml and venous thrombosis.Multivariate analysis showed that stage(HR=3.475, 95%CI：1.559-7.744, P =0.002) and platinum resistance (HR=9.325, 95%CI：4.076-21.334, P ＜ 0.001) were independent risk factors for the overall survival time of patients. (Table 2) Table 2. Univariable and multivariate analysis (OS) Program Univariable analysis Multivariate analysis HR 95%CI P HR 95%CI P Age ≥50（vs＜50） 1.121 0.620-2.027 0.706 Complicated with endometriosis Yes（vs No） 0.445 0.225-0.881 0.020 0.552 0.268-1.134 0.106 Stage Advanced stage（vs early stage） 5.773 3.113-10.706 ＜0.001 3.475 1.559-7.744 0.002 Initial CA125(U/ml)（n=55） Elevated（vs normal） 27.757 0.231-3332.402 0.174 Initial lymph node metastasis Positive（vs negative） 2.916 1.225-6.942 0.016 2.179 0.768-6.182 0.143 Chemotherapy Yes（vs No） 0.386 0.152-0.983 0.046 0.493 0.158-1.533 0.222 Chemotherapy regimen EP（vs TP） 0.487 0.067-3.546 0.477 CA125 normalization（n=88）（vs no normalized） ＜0.001 Early phase normalized 0.121 0.054-0.271 ＜0.001 Late phase normalized 0.208 0.081-0.534 0.001 final CA125(U/ml)（n=83） ≤20（vs＞20） 0.161 0.081-0.321 ＜0.001 Venous thrombosis Yes（vs No） 4.154 1.977-8.727 ＜0.001 1.565 0.669-3.661 0.301 Platinum chemoresistance Yes（vs No） 15.534 7.421-32.515 ＜0.001 9.325 4.076-21.334 ＜0.001 Analysis of progression-free survival time of 102 patients The COX risk regression model's univariate analysis revealed that progression-free survival time (PFS) was associated with stages, concurrent endometriosis, chemotherapy, standardized treatment, platinum chemoresistance, CA-125 normalization, the last CA125≤20U/ml, and venous thrombosis. Multivariate analysis showed that platinum resistance (HR=62.709, 95%CI：18.687-210.431, P ＜ 0.001) was an independent risk factor for the progression-free survival of patients. (Table 3) Table 3. Univariable and multivariate analysis (PFS) Program Univariable analysis Multivariate analysis HR 95%CI P HR 95%CI P Age ≥50（vs＜50） 1.001 0.550-1.821 0.998 Complicated with endometriosis Yes（vs No） 0.401 0.197-0.814 0.011 0.598 0.280-1.276 0.184 Stage Advanced stage（vs early stage） 5.773 3.113-10.706 ＜0.001 1.232 0.535-2.835 0.624 Initial CA125(U/ml)（n=55） Elevated（vs normal） 29.000 0.276-3046.311 0.156 Initial lymph node metastasis Positive（vs negative） 1.591 0.567-4.466 0.378 2.179 0.768-6.182 0.143 Chemotherapy Yes（vs No） 0.759 0.234-2.456 0.645 Chemotherapy regimen EP（vs TP） 0.452 0.062-3.291 0.433 CA125 normalization（n=88）（vs no normalized） 0.028 Early phase normalized 0.314 0.130-0.760 0.010 Late phase normalized 0.566 0.209-1.535 0.264 final CA125(U/ml)（n=83） ≤20（vs＞20） 0.277 0.137-0.559 ＜0.001 Venous thrombosis Yes（vs No） 4.852 2.301-10.229 ＜0.001 Platinum chemoresistance Yes（vs No） 55.822 20.302-153.483 ＜0.001 62.709 18.687-210.431 ＜0.001 Survival analysis curves for the associated factors Comparison between the OS and PFS survival curves using the log-rank test: ① To analyze whether there were differences in OS and PFS in the 3 groups of patients with CA125 value decreased to normal time, the results showed that there were significant differences in OS and PFS in the early normalized group, late normalized group and no normal group (P <0.001) (Figure 2). ② Analyze whether the OS and PFS of the 102 patients who completed the standard treatment or not, the results showed that the OS (P <0.001 between the standard treatment group (P <0.001), and there was no significant difference in PFS (P=0.146) (Figure 3). ③ Analyze whether the OS and PFS of the two patients with resistance to platinum chemotherapy were different, and the results showed that the OS of the patients with with and without platinum chemotherapy resistance were significantly different in PFS (P <0.001) (Figure 4). Discussion Patients with stage I ovarian clear cell carcinoma accounted for 62.7% of the total clear cell patients with ovarian cancer in the same period, which is slightly higher than the previously reported proportion. This is similar to the 66% proportion reported by Okamoto et al [8] . The level of CA125 varies greatly among individuals with clear cell carcinoma before treatment, and more than half of the patients can show a significant increase, which is beneficial for early identification and diagnosis of tumors. However, some patients may have CA125 levels within the normal range before treatment, and during recurrence and metastasis, which can create confusion and difficulties for diagnostic.CA125 is the most widely used marker for gynecological malignant tumors, but its diagnostic and prognostic value in patients with clear cell carcinoma is still being debated. In this study, 10.87% of patients had a normal CA125 level at diagnosis, and whether the CA125 level was normal at diagnosis was not related to prognosis (P>0.05). However, other studies have found that the time of normalization of CA125 during chemotherapy is related to prognosis. The time when CA125 decreased to normal during treatment was closely related to OS and PFS (P < 0.001).The patients with CA125 decreasing to normal as early as possible had better outcomes than those who never decreased to normal. Additionally, the last CA125 value was closely related to prognosis when the cut-off point was 20U/ml. Patients with the last CA125 value less than or equal to 20U/ml had longer PFS and OS. Therefore, although the value of serum CA125 may not be helpful in the diagnosis of ovarian clear cell carcinoma, it can assist in adjusting treatment plans and screening high-risk patients who are prone to recurrence and metastasis during follow-up. Most ovarian clear cell carcinomas (OCCC) arise from the same precursor lesion as endometrioid carcinoma of the ovary - endometriosis (EMs). In our study, three cases of OCCC complicated with endometrial carcinoma were associated with intraovarian endometriosis or adenomyosis, providing further evidence of the relationship between these conditions. About 50% to 74% of OCCCs with EMs, with ovarian EMs being the most common, have been reported in previous studies [12] . In our study, the proportion of OCCC cases with EMs was 39.2%, which is lower than previously reported. Prognostic analysis revealed that OCCCs with EMs had a better overall prognosis (Prun=0.084) (Figure 3), consistent with the results of previous case studies. Additionally, the symptoms of EMs may prompt patients to seek medical attention earlier, facilitating early detection of OCCC [13,14] . In our study, 74.3% of patients with OCCCs with EMs were diagnosed with stage I disease, which is higher than the 62.7% of patients with stage I disease (45.4%) and higher than the overall rate of all patients (39.2%). The clinical stage is a crucial prognostic factor for OCCC (P < 0.001) , with stage Ⅱ/Ⅲ lymph node metastasis at the first visit being the most closely related to the prognosis (P=0.004) [15] . The 3-year, 5-year, and 10-year OS rates for OCCC patients are as follows: 81.7%, 68.9%, and 50.0% for stage Ⅰ-Ⅱ, while 30.0%, 20.0%, and 0.0% for stage Ⅲ-Ⅳ. This suggests that the survival rate of late-stage patients is significantly lower than that of early-stage patients, emphasizing the importance of early detection and treatment [16] . Although this study's multivariate analysis shows that clinical stage and lymph node metastasis at first diagnosis are not independent prognostic factors of OS and PFS, this may be due to the limited number of cases in this study. For instance, Jennifer A Bennett et al [17] , who used logarithmic rank test and Kaplan-Meier analysis to evaluate prognostic parameters of OCCC, concluded that staging and lymph node status were the only parameters with statistical significance (P < 0.0001). In terms of treatment, surgery is the primary approach for managing ovarian cancer. TAKANOM et al reported that patients with epithelial ovarian cancer who underwent satisfactory tumor reduction surgery (residual lesions < 1cm) had a significant survival advantage over those who did not [18] . However, Sugiyama et al. [19] showed that residual tumor size did not have a significant impact on survival rates. The results of data analysis in this study showed no significant difference in the effect of surgery on survival rates (P=0.495), except for 2 patients with stage IV. Most patients underwent satisfactory tumor reduction with few negative data and bias, but the accuracy of the results cannot be guaranteed. Chemotherapy plays an important role in the treatment of OCCC. Routine postoperative chemotherapy with standard platinum-based chemotherapy TP (paclitaxel + cisplatin) or TC (paclitaxel + carboplatin). The effective rate of standard platinum-based chemotherapy in ovarian cancer was only about 30%, which was significantly lower than that of HGSC; TAKANOM [20] et al reported that the response rate of paclitaxel and carboplatin was 22% to 56%. In this study, paclitaxel chemotherapy (P=0.046) had a significant effect on survival in patients with OCCC.Completion of surgery and more than three cycles of chemotherapy was considered as potential contributing factors. In this study, the incidence of platinum resistance was 38.2%, and platinum resistance was an independent risk factor for progression-free survival (P <0.001) . Our study was a retrospective single-center study.A larger prospective multi-center study is needed for further prospective external validation. Conclusion This study demonstrated that platinum chemotherapy resistance is the most significant prognostic factor for patients with ovarian clear cell carcinoma. Staging, lymph node status, and venous thrombosis are also associated with prognosis. Declarations Ethics approval The study was approved by the ethics committee at the Fujian Medical University Cancer Hospital Fuzhou, Fujian, China (Ethical approval number: K2023-045-01 ).All participants signed an informed consent form. Competing interests The authors declare that there are no competing interests in this study. Data Availability Statements The data that support the findings of this study are available from the corresponding author upon reasonable request. Author contributions Xingyun Xie conceived and designed the analysis and wrote the paper. Yuting Wei collected the data and performed the analysis. Wenjuan Chen and Chenying Liu Contributed data and analysis tools. Rongrong Wu collected the data. Funding This work was supported by Fujian Provincial Health Technology Project (2017-CX-8 and 2021CXA031), Startup Fund for Scientific research, Fujian Medical University (Grant number:2021QH1146), and also supported by Fujian Clinical Research Center for Radiation and Therapy of Digestive, Respiratory and Genitourinary Malignancies（2021Y2014）. Acknowledgements The authors would like to show their sincere gratitude to all the patients and their families involved in this study. References Trends and characteristics of epithelial ovarian cancer in Japan between 2002 and 2015:A JSGO-JSOG joint study Ovarian Cancer Statistics,2018 ANGLESIO MS,CAREY MS,KOBEL M,et al.Clear cell carcinoma of the ovary:a report from the first Ovarian Clear Cell Symposium,June 24th,2010[J].Gynecol Oncol,2011,121(2):407–415. FUJIWARA K,SHINTANI D,NISHIKAWA T.Clear-cell carcinoma of the ovary[J].Ann Oncol,2016,27 Suppl 1:i50 -i52. Takahashi K,Takenaka M,Kawabata A,et al. 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Zhao T,Shao Y,Liu Y,et al.Endometriosis does not confer improved prognosis in ovarian clear cell carcinoma:a retrospective study at a single institute[J].J Ovarian Res,2018,11:53. SAMPSON J.Endometrial carcinoma of the ovary arising in endometrial tissue in that organ[J].Arch Surg,1925,10(1):1–72. SCOTT R B.Malignant changes in endometriosis[J].Obstet Gynecol, 1953,2(3):283–289. Jennifer A Bennett, Fei Dong,et al.Clear cell carcinoma of the ovary: evaluation of prognostic parameters based on a clinicopathological analysis of 100 Cases[J]. Histopathology 2015, 66, 808–815. TAKANO M,TSUDA H,SUGIYAMA T.cell carcinoma of the ovary:is there a role of histology-specific treatment[J].J Exp Clin Cancer Res,2012,31(1):53. [16]SHIKAMA A,MINAGUCHI T,TAKAO W,et al.Predicto SAMPSON J.Endometrial carcinoma of the ovary arising in endometrial tissue in that organ[J].Arch Surg,1925,10(1):1–72 TAKANO M,SUGIYAMA T,YAEGASHI N,et al.Progressionfree survival and overall survival of patients with clear cell carcinoma of the ovary treated with paclitaxel-carboplatin or irinotecancisplatin:retrospective analysis[J].Int J Clin Oncol,2007,12 (4):256–260 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4637467","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":331680828,"identity":"e80dd4ab-4432-4615-96f5-c1c9de516dae","order_by":0,"name":"Xingyun Xie","email":"","orcid":"","institution":"Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xingyun","middleName":"","lastName":"Xie","suffix":""},{"id":331680830,"identity":"74136df5-e64b-4e5e-a3d8-0d9e7b13df63","order_by":1,"name":"Yuting wei","email":"","orcid":"","institution":"Fudan 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15:17:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4637467/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4637467/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61349695,"identity":"26bf0b86-e84f-4657-b98d-dbec8c3c4918","added_by":"auto","created_at":"2024-07-29 18:32:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":34598,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves for patients between different \u0026nbsp;\u0026nbsp;stages:overall survival（A），progression-free survival PFS（B）\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4637467/v1/ed09f291d50a9220a4ecd13e.jpg"},{"id":61350542,"identity":"85c5d881-0ec7-4cc0-ba53-e473d1b30914","added_by":"auto","created_at":"2024-07-29 18:40:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36939,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival curves for patients among different CA-125 \u0026nbsp;\u0026nbsp;normalization:overall survival（A），progression-free survival PFS（B）\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4637467/v1/680ff22099e3e96ca6ccfa8c.jpg"},{"id":61348865,"identity":"e26d9f2e-d76f-44d9-9d41-7a2855ed1f51","added_by":"auto","created_at":"2024-07-29 18:24:57","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29026,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier \u0026nbsp;\u0026nbsp;survival curves for patients who received standardized treatment and \u0026nbsp;\u0026nbsp;not:overall survival（A），progression-free survival PFS（B）\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4637467/v1/fae01c51419a0645c7a7fd7d.jpg"},{"id":61348863,"identity":"00882097-1afd-49f6-9525-d302ee7895e9","added_by":"auto","created_at":"2024-07-29 18:24:57","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":28620,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier \u0026nbsp;\u0026nbsp;survival curves for patients with platinum chemoresistance and not:overall \u0026nbsp;\u0026nbsp;survival（A），progression-free survival PFS（B）\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4637467/v1/8835abc3df0c2999a7f8b0fa.jpg"},{"id":69762300,"identity":"be1ebf76-cef9-4cd3-a7b3-b892e8e2df2f","added_by":"auto","created_at":"2024-11-25 04:54:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":791879,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4637467/v1/d5ea0aaf-a971-4ee5-867d-f460d90c666d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of prognostic-related risk factors in ovarian clear cell carcinoma","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOvarian cancer (ovarian cancer, OC) is one of the three major gynecological malignant tumors, with high malignancy, insidious onset, and higher fatality rate than other gynecological malignancies. Epithelial ovarian cancer (epithelial ovarian cancer, EOC) accounts for about 90% of ovarian cancer.Among them, ovarian clear cell carcinoma (OCCC) accounts for about 6% \u003csup\u003e[1,2]\u003c/sup\u003e. Compared with other ovarian cancers, ovarian clear cell carcinoma has unique biological characteristics histologically and prognoses\u003csup\u003e[3]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe onset of OCCCs, with obvious ethnic and geographical differences\u003csup\u003e[4]\u003c/sup\u003e. In Asia, the incidence rate is the highest in Japan, accounting for 15%~25% \u003csup\u003e[5]\u003c/sup\u003e. In China, OCCC accounted for 9.7% of all EOCs according to the study by Wang S et al\u003csup\u003e[6]\u003c/sup\u003e.The median age of ovarian clear cell carcinoma was 55 years versus 64 years for ovarian serous carcinoma\u003csup\u003e[7]\u003c/sup\u003e.About 90% of patients had a tumorconfined to unilateral ovarian, but only 19\u0026ndash;22% bilaterally\u003csup\u003e[8,9]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough most OCCC can be detected in the early stage, The treatment of OCCC is standard staging surgery or tumor cytoreduction as far as possible.someadvanced patients undergo intermediate tumor cytoreduction after neoadjuvant chemotherapy.Most of the patients received platinum-based chemotherapy regimens as the postoperative first-line treatment.it still has a high tendency of recurrence after chemotherapy\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOCCC has related prognostic risk factors, such as demographic characteristics, stage, combined endometriosis (endometriosis, EMs), molecular features, surgical methods, postoperative tumor residual, adjuvant therapy, and combined venous thrombosis (venous thromboembolism, VTE). There has been little progress in the treatment of OCCC in the last ten years.So in this study, the clinical characteristics, survival and prognosis of 102 patients were reviewed to explore the prognostic factors related to treatment.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003ePatients\u003c/h2\u003e\n \u003cp\u003eA total of 102 patients diagnosed as ovarian clear cell carcinoma were collected from January 2007 to December 2018. Detailed clinical data were collected by consulting medical records and clinical follow-up data, including age, menstrual status, complaint symptoms, CA125 level, FIGO stage, tumor size and side, operation type, preoperative or intraoperative tumor rupture, ascites, stage, presence of endometriosis (ovarian and / or outside ovary), efficacy evaluation and recurrence.\u003c/p\u003e\n \u003cp\u003eThe following conditions were met: (1) histologically confirmed pure-OCCC type. (2) surgery was performed in Fujian cancer hospital. (3) standard treatment was completed. (4) postoperative follow-up was standardized and completed. All included patients have provided written informed consent to use their clinical data. The study was approved by the Ethics Committee of Fujian Cancer Hospital (Ethical approval number:K2023-045-01). We confirmed that all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eFollow-up\u003c/h2\u003e\n \u003cp\u003eChemotherapeutic resistance was defined as definite tumor progression or recurrence within six months from the last chemotherapy. Postoperative survival data were obtained through outpatient or telephone follow-up, and the final follow-up period was in March 2022. In cases where there was no follow-up information in the past six months, patients were classified as lost to follow-up. Survival analysis included overall survival (OS) and disease-free survival (DFS). OS was defined as the time from the first operation to death or last follow-up. DFS was defined as the time from initial surgical treatment to the occurrence of tumor progression/recurrence.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eStatistical analysis was performed using Statistical Package for Social Science (SPSS)statistical software (Version 25.0, SPSSInc, Ch icago, Ill) and multivariate COX regression analysis was used to analyze the clinical prognosis. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Risk factors with a P\u0026thinsp;\u0026lt;\u0026thinsp;0.10 were selected for inclusion in multivariate COX regression analysis, and the difference was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eClinical and pathological characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 102 cases of ovarian clear cell carcinoma were included, among which 64 cases were at stageⅠ(62.1%), 18 cases at stage\u0026nbsp;Ⅱ(17.6%), 16 cases at stage\u0026nbsp;Ⅲ\u0026nbsp;(15.7%), and 4 cases at stage\u0026nbsp;Ⅳ\u0026nbsp;(3.9%). The age ranged from 31 to 72 years old (49.40 \u0026plusmn; 7.94) with a median age of 49 years old. Among them, 65 cases (63.7%) presented with abdominal mass, 22 cases (21.5%) with abdominal pain, 8 cases (7.8%) with abdominal distension, and 2 cases (1.9%) with postmenopausal vaginal bleeding. One case was complicated with endometrial carcinoma at stage Ia, while the other 5 cases (4.8%) were due to menstrual disorder (2 cases), frequent urination (2 cases), and dysuria (1 case).\u003c/p\u003e\n\u003cp\u003eAmong the 102 ovarian clear cell carcinomas, 6 (6.0%) were complicated with other malignancies. 40 patients (39.2%) with endometriosis. All patients received first-line chemotherapy with a mean of 5.38 \u0026plusmn; 2.51 cycles.34 (36.2%) showed resistance. Forty-three patients (42.7%) experienced recurrence, and 38 patients (88.3%) caused deaths, accounting for 86.4% of the total number of deaths in this study. The overall survival time was (60.67 \u0026plusmn; 39.04) months, and the median survival time was 52.84 months. Disease-free progression survival time was (52.63 \u0026plusmn; 42.43) months and the median survival time was 45.10 months.(Table 1 )\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Clinical characteristics and survival of patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003ePercentage \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e52.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003ePrincipal complaint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eLower abdominal pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003ePelvic mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e63.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eAbdominal distention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eMenstrual disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eIrregular vaginal bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eSychnuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eDysuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eComplicated with endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e60.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e39.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eIntraovarian endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eAdenomyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e4.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eSide of tumor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eUnilateral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eBoth sides\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eOperation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e98.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e93.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eTP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e90.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003ePlatinum chemoresistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e63.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy cycles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e81.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eRecurrence or metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e42.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e57.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eVenous thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e91.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eSurvival state\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eSurvived\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.706422018348626%\" valign=\"top\"\u003e\n \u003cp\u003eDied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.01834862385321%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.275229357798164%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviations: TP, Paclitaxel plus platinum; EP, Etoposidel plus platinum.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSurvival analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll 102 patients were followed for more than 3 years, with a median follow-up time of 89.62 months (range from 40.1 to 182.7 months). The median OS of the patients was 52.84 months, and the PFS was 45.10 months. The 3-year, 5-year and 10-year OS rates were 71.6%, 59.2% and 44.4%, respectively; the 3-year, 5-year and 10-year PFS rates were 56.9%, 50.0% and 38.9%, respectively. The comparison of OS rates and PFS rates between early (I~Ⅱ) and late (Ⅲ~Ⅵ) patients is shown in Figure 1. The median OS and PFS of early patients did not reach the end point, and the median OS and PFS of advanced patients were 20.84 months and 10.45 months, respectively, showing a statistically significant difference (P \u0026lt;0.001).(Figure 1)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of the total survival time of 102 patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnivariate analysis of the COX risk regression model showed that overall survival time (OS) was associated with stages, concurrent endometriosis, chemotherapy, Initial lymph node metastasis, platinum chemoresistance, CA-125 normalization, the last CA125\u0026le;20U/ml and venous thrombosis.Multivariate analysis showed that stage(HR=3.475, 95%CI：1.559-7.744, \u003cem\u003eP\u003c/em\u003e=0.002) and platinum resistance (HR=9.325, 95%CI：4.076-21.334, \u003cem\u003eP\u003c/em\u003e\u003cem\u003e＜\u003c/em\u003e0.001) were independent risk factors for the overall survival time of patients. (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Univariable and multivariate analysis (OS)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"543\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.58823529411765%\" rowspan=\"2\"\u003e\n \u003cp\u003eProgram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.80882352941177%\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariable \u0026nbsp;analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.60294117647059%\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.064965197215777%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.361948955916475%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.081206496519721%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.761020881670534%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.577726218097446%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.153132250580047%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003e\u0026ge;50（vs＜50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e1.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.620-2.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eComplicated with endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.225-0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e0.268-1.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eAdvanced stage（vs early stage）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e5.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e3.113-10.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e3.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e1.559-7.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eInitial CA125(U/ml)（n=55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eElevated（vs normal）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e27.757\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.231-3332.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eInitial lymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003ePositive（vs\u0026nbsp;negative）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e2.916\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e1.225-6.942\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e2.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e0.768-6.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.152-0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e0.158-1.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eChemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eEP（vs\u0026nbsp;TP）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.067-3.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.477\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eCA125 normalization（n=88）（vs\u0026nbsp;no normalized）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eEarly phase\u0026nbsp;normalized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.054-0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eLate phase\u0026nbsp;normalized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.081-0.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003efinal CA125(U/ml)（n=83）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003e\u0026le;20（vs＞20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e0.081-0.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eVenous thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e4.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e1.977-8.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e1.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e0.669-3.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003ePlatinum chemoresistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.626151012891345%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.576427255985267%\"\u003e\n \u003cp\u003e15.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.337016574585636%\"\u003e\n \u003cp\u003e7.421-32.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.970534069981584%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.128913443830571%\"\u003e\n \u003cp\u003e9.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.12707182320442%\"\u003e\n \u003cp\u003e4.076-21.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.233885819521179%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis of progression-free survival time of 102 patients\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe COX risk regression model\u0026apos;s univariate analysis revealed that progression-free survival time (PFS) was associated with stages, concurrent endometriosis, chemotherapy, standardized treatment, platinum chemoresistance, CA-125 normalization, the last CA125\u0026le;20U/ml, and venous thrombosis. Multivariate analysis showed that platinum resistance (HR=62.709, 95%CI：18.687-210.431,\u0026nbsp;\u003cem\u003eP\u003c/em\u003e\u003cem\u003e＜\u003c/em\u003e0.001) was an independent risk factor for the progression-free survival of patients.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(Table 3)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Univariable and multivariate analysis (PFS)\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"543\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.58823529411765%\" rowspan=\"2\"\u003e\n \u003cp\u003eProgram\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.80882352941177%\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariable \u0026nbsp;analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"38.60294117647059%\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"11.86046511627907%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.41860465116279%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.116279069767442%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.790697674418604%\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.627906976744185%\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.186046511627907%\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003e\u0026ge;50（vs＜50）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.550-1.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eComplicated with endometriosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.197-0.814\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e0.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e0.280-1.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e0.184\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eAdvanced stage（vs early stage）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e5.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e3.113-10.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e1.232\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e0.535-2.835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eInitial CA125(U/ml)（n=55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eElevated（vs normal）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e29.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.276-3046.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eInitial lymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003ePositive（vs\u0026nbsp;negative）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\" valign=\"top\"\u003e\n \u003cp\u003e1.591\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\" valign=\"top\"\u003e\n \u003cp\u003e0.567-4.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\" valign=\"top\"\u003e\n \u003cp\u003e0.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e2.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e0.768-6.182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.234-2.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eChemotherapy regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eEP（vs\u0026nbsp;TP）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.062-3.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eCA125 normalization（n=88）（vs\u0026nbsp;no normalized）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eEarly phase\u0026nbsp;normalized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.130-0.760\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eLate phase\u0026nbsp;normalized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.209-1.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003efinal CA125(U/ml)（n=83）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003e\u0026le;20（vs＞20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e0.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e0.137-0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eVenous thrombosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e4.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e2.301-10.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003ePlatinum chemoresistance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.66420664206642%\"\u003e\n \u003cp\u003eYes（vs\u0026nbsp;No）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.409594095940959%\"\u003e\n \u003cp\u003e55.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.372693726937268%\"\u003e\n \u003cp\u003e20.302-153.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.992619926199263%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.14760147601476%\"\u003e\n \u003cp\u003e62.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.15867158671587%\"\u003e\n \u003cp\u003e18.687-210.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.254612546125461%\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eSurvival analysis curves for the associated factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eComparison between the OS and PFS survival curves using the log-rank test:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e① To analyze whether there were differences in OS and PFS in the 3 groups of patients with CA125 value decreased to normal time, the results showed that there were significant differences in OS and PFS in the early normalized group, late normalized group and no normal group (P \u0026lt;0.001) (Figure 2).\u003c/p\u003e\n\u003cp\u003e② Analyze whether the OS and PFS of the 102 patients who completed the standard treatment or not, the results showed that the OS (P \u0026lt;0.001 between the standard treatment group (P \u0026lt;0.001), and there was no significant difference in PFS (P=0.146) (Figure 3).\u003c/p\u003e\n\u003cp\u003e③ Analyze whether the OS and PFS of the two patients with resistance to platinum chemotherapy were different, and the results showed that the OS of the patients with with and without platinum chemotherapy resistance were significantly different in PFS (P \u0026lt;0.001) (Figure 4).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePatients with stage I ovarian clear cell carcinoma accounted for 62.7% of the total clear cell patients with ovarian cancer in the same period, which is slightly higher than the previously reported proportion. This is similar to the 66% proportion reported by Okamoto et al \u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe level of CA125 varies greatly among individuals with clear cell carcinoma before treatment, and more than half of the patients can show a significant increase, which is beneficial for early identification and diagnosis of tumors. However, some patients may have CA125 levels within the normal range before treatment, and during recurrence and metastasis, which can create confusion and difficulties for diagnostic.CA125 is the most widely used marker for gynecological malignant tumors, but its diagnostic and prognostic value in patients with clear cell carcinoma is still being debated. In this study, 10.87% of patients had a normal CA125 level at diagnosis, and whether the CA125 level was normal at diagnosis was not related to prognosis (P\u0026gt;0.05). However, other studies have found that the time of normalization of CA125 during chemotherapy is related to prognosis. The time when CA125 decreased to normal during treatment was closely related to OS and PFS (P \u0026lt; 0.001).The patients with CA125 decreasing to normal as early as possible had better outcomes than those who never decreased to normal. Additionally, the last CA125 value was closely related to prognosis when the cut-off point was 20U/ml. Patients with the last CA125 value less than or equal to 20U/ml had longer PFS and OS. Therefore, although the value of serum CA125 may not be helpful in the diagnosis of ovarian clear cell carcinoma, it can assist in adjusting treatment plans and screening high-risk patients who are prone to recurrence and metastasis during follow-up.\u003c/p\u003e\n\u003cp\u003eMost ovarian clear cell carcinomas (OCCC) arise from the same precursor lesion as endometrioid carcinoma of the ovary - endometriosis (EMs). In our study, three cases of OCCC complicated with endometrial carcinoma were associated with intraovarian endometriosis or adenomyosis, providing further evidence of the relationship between these conditions. About 50% to 74% of OCCCs with EMs, with ovarian EMs being the most common, have been reported in previous studies\u003csup\u003e\u0026nbsp;[12]\u003c/sup\u003e. In our study, the proportion of OCCC cases with EMs was 39.2%, which is lower than previously reported. Prognostic analysis revealed that OCCCs with EMs had a better overall prognosis (Prun=0.084) (Figure 3), consistent with the results of previous case studies. Additionally, the symptoms of EMs may prompt patients to seek medical attention earlier, facilitating early detection of OCCC \u003csup\u003e[13,14]\u003c/sup\u003e. In our study, 74.3% of patients with OCCCs with EMs were diagnosed with stage I disease, which is higher than the 62.7% of patients with stage I disease (45.4%) and higher than the overall rate of all patients (39.2%).\u003c/p\u003e\n\u003cp\u003eThe clinical stage is a crucial prognostic factor for OCCC (P \u0026lt; 0.001) , with stage Ⅱ/Ⅲ lymph node metastasis at the first visit being the most closely related to the prognosis (P=0.004) \u003csup\u003e[15]\u003c/sup\u003e. The 3-year, 5-year, and 10-year OS rates for OCCC patients are as follows: 81.7%, 68.9%, and 50.0% for stage Ⅰ-Ⅱ, while 30.0%, 20.0%, and 0.0% for stage Ⅲ-Ⅳ. This suggests that the survival rate of late-stage patients is significantly lower than that of early-stage patients, emphasizing the importance of early detection and treatment \u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAlthough this study\u0026apos;s multivariate analysis shows that clinical stage and lymph node metastasis at first diagnosis are not independent prognostic factors of OS and PFS, this may be due to the limited number of cases in this study. For instance, Jennifer A Bennett et al \u003csup\u003e[17]\u003c/sup\u003e, who used logarithmic rank test and Kaplan-Meier analysis to evaluate prognostic parameters of OCCC, concluded that staging and lymph node status were the only parameters with statistical significance (P \u0026lt; 0.0001).\u003c/p\u003e\n\u003cp\u003eIn terms of treatment, surgery is the primary approach for managing ovarian cancer. TAKANOM et al reported that patients with epithelial ovarian cancer who underwent satisfactory tumor reduction surgery (residual lesions \u0026lt; 1cm) had a significant survival advantage over those who did not \u003csup\u003e[18]\u003c/sup\u003e. However, Sugiyama et al. \u003csup\u003e[19]\u003c/sup\u003e showed that residual tumor size did not have a significant impact on survival rates. The results of data analysis in this study showed no significant difference in the effect of surgery on survival rates (P=0.495), except for 2 patients with stage IV. Most patients underwent satisfactory tumor reduction with few negative data and bias, but the accuracy of the results cannot be guaranteed.\u003c/p\u003e\n\u003cp\u003eChemotherapy plays an important role in the treatment of OCCC. Routine postoperative chemotherapy with standard platinum-based chemotherapy TP (paclitaxel + cisplatin) or TC (paclitaxel + carboplatin). The effective rate of standard platinum-based chemotherapy in ovarian cancer was only about 30%, which was significantly lower than that of HGSC; TAKANOM\u003csup\u003e[20]\u003c/sup\u003e et al reported that the response rate of paclitaxel and carboplatin was 22% to 56%. In this study, paclitaxel chemotherapy (P=0.046) had a significant effect on survival in patients with OCCC.Completion of surgery and more than three cycles of chemotherapy was considered as potential contributing factors. In this study, the incidence of platinum resistance was 38.2%, and platinum resistance was an independent risk factor for progression-free survival (P \u0026lt;0.001) .\u003c/p\u003e\n\u003cp\u003eOur study was a retrospective single-center study.A larger prospective multi-center study is needed for further prospective external validation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that platinum chemotherapy resistance is the most significant prognostic factor for patients with ovarian clear cell carcinoma. Staging, lymph node status, and venous thrombosis are also associated with prognosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee at the Fujian Medical University Cancer Hospital Fuzhou, Fujian, China (Ethical approval number: K2023-045-01 ).All participants signed an informed consent form.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no competing interests in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXingyun Xie conceived and designed the analysis and wrote the paper. Yuting Wei collected the data and performed the analysis. Wenjuan Chen and Chenying Liu \u0026nbsp;Contributed data and analysis tools. Rongrong Wu collected the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Fujian Provincial Health Technology Project (2017-CX-8 and 2021CXA031), Startup Fund for Scientific research, Fujian Medical University (Grant number:2021QH1146), and also supported by Fujian Clinical Research Center for Radiation and Therapy of Digestive, Respiratory and Genitourinary Malignancies（2021Y2014）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to show their sincere gratitude to all the patients and their\u003c/p\u003e\n\u003cp\u003efamilies involved in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTrends and characteristics of epithelial ovarian cancer in Japan between 2002 and 2015:A JSGO-JSOG joint study\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOvarian Cancer Statistics,2018\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eANGLESIO MS,CAREY MS,KOBEL M,et al.Clear cell carcinoma of the ovary:a report from the first Ovarian Clear Cell Symposium,June 24th,2010[J].Gynecol Oncol,2011,121(2):407\u0026ndash;415.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFUJIWARA K,SHINTANI D,NISHIKAWA T.Clear-cell carcinoma of the ovary[J].Ann Oncol,2016,27 Suppl 1:i50 -i52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakahashi K,Takenaka M,Kawabata A,et al. Rethinking of treatment strategies and clinical managementin ovarian clear cell carcinoma[J].Int J Clin Oncol,2020,25(3):425\u0026ndash;431.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakano M,Kikuchi Y,Yaegashi N,et al. Clear cell carcinoma of the ovary:a retrospective multicentre experience of 254 patients with complete surgical staging[ J]. Bri J Cancer, 2006,94(10):1369\u0026ndash;1374\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan JK,Teoh D,Hu JM,et al. Do clear cell ovarian carcinomas have poorer prognosis compared to other epithelial cell types? A study of 1411 clear cell ovarian cancers [J]. Gynecol Oncol, 2008,109(3):370\u0026ndash;376\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkamoto A,Sugiyama T,Hamano T,et al. Randomized phase III trial of paclitaxel/ carboplatin (PC) versus cisplatin/ irinotecan (CPT-P) as first-line chemotherapy in patients with clear cell carcinoma (CCC) of the ovary:A Japanese Gynecologic Oncology Group (JGOG) / GCIG study[J]. J Clin Oncol,2014,32(5s):5507\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKobayashi H,Sugimoto H,Onishi S,et al. Novel biomarker candidates for the diagnosis of ovarian clear cell carcinoma (Review)[J]. Oncol Lett,2015,10(2):612\u0026ndash;618\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai H,Sha G,Xiao M,et al.The prognostic value of pretreatment CA-125 levels and CA-125 normalization in ovarian clear cell carcinoma:a two-academic-institute study[J].Oncotarget,2016,7:15566\u0026ndash;15576.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang JH,Bo D,Chang XH,et al. Discrepant clinicopathologic characteristics and HE4 performance in type I and type II epithelial ovarian cancer[J]. Int J Clin Exp Med. 2015,8(11):21303\u0026ndash;21310\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSon JH,Yoon S,Kim S,et al. Clinicopathologic characteristics of ovarian clear cell carcinoma in the background of endometrioma: a surveillance strategy for an early detection of malignant transformation in patients with asymptomatic endometrioma[J]. Obstet Gynecol Sci, 2019,62(1):27\u0026ndash;34\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGadducci A,Multinu F,Stefania CS,et al.Clear cell carcinoma of the ovary:epidemiology,pathological and biological features,treatment options and clinical outcomes[J].Gynecol Oncol,2021,162:741\u0026ndash;750.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao T,Shao Y,Liu Y,et al.Endometriosis does not confer improved prognosis in ovarian clear cell carcinoma:a retrospective study at a single institute[J].J Ovarian Res,2018,11:53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAMPSON J.Endometrial carcinoma of the ovary arising in endometrial tissue in that organ[J].Arch Surg,1925,10(1):1\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSCOTT R B.Malignant changes in endometriosis[J].Obstet Gynecol, 1953,2(3):283\u0026ndash;289.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJennifer A Bennett, Fei Dong,et al.Clear cell carcinoma of the ovary: evaluation of prognostic parameters based on a clinicopathological analysis of 100 Cases[J]. Histopathology 2015, 66, 808\u0026ndash;815.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTAKANO M,TSUDA H,SUGIYAMA T.cell carcinoma of the ovary:is there a role of histology-specific treatment[J].J Exp Clin Cancer Res,2012,31(1):53. [16]SHIKAMA A,MINAGUCHI T,TAKAO W,et al.Predicto\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAMPSON J.Endometrial carcinoma of the ovary arising in endometrial tissue in that organ[J].Arch Surg,1925,10(1):1\u0026ndash;72\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTAKANO M,SUGIYAMA T,YAEGASHI N,et al.Progressionfree survival and overall survival of patients with clear cell carcinoma of the ovary treated with paclitaxel-carboplatin or irinotecancisplatin:retrospective analysis[J].Int J Clin Oncol,2007,12 (4):256\u0026ndash;260\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ovarian cancer, clear cell carcinoma, clinical features, risk factors, prognosis","lastPublishedDoi":"10.21203/rs.3.rs-4637467/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4637467/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo analyze the clinical characteristics of patients with ovarian clear cell carcinoma and to explore the prognostic-related risk factors.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe retrospectively analyzed 102 patients diagnosed with ovarian clear cell carcinoma (OCCC) in Fujian Cancer Hospital from January 2007 to December 2018. Progression-free survival time (PFS) and overall survival time (OS) were estimated by Kaplan-Meier curve, and Cox proportional hazards regression analysis were summarized for the clinical outcomes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe median follow-up time of 102 patients was 89.62 months. The 5-year overall survival (OS) and progression-free survival (PFS) were 59.2% and 50.0%. Cox regression univariate analysis showed that stages, concurrent endometriosis, chemotherapy, standardized treatment, platinum chemoresistance, CA-125 normalization, the last CA125\u0026thinsp;\u0026le;\u0026thinsp;20U/ml, and venous thrombosis were associated with OS and PFS (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). The lymph node status was only related to OS (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.05). Multivariate analysis showed that stage (HR\u0026thinsp;=\u0026thinsp;3.475, 95%CI: 1.559\u0026ndash;7.744, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), standardized treatment (HR\u0026thinsp;=\u0026thinsp;0.298, 95%CI༚0.137\u0026ndash;0.648, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) and platinum resistance (HR\u0026thinsp;=\u0026thinsp;9.325, 95%CI༚4.076\u0026ndash;21.334, \u003cem\u003eP\u0026lt;\u003c/em\u003e0.001) were independent prognostic factors for OS. Standard treatment (HR\u0026thinsp;=\u0026thinsp;0.347, 95%CI༚0.161\u0026ndash;0.750, \u003cem\u003eP\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.007) and platinum resistance (HR\u0026thinsp;=\u0026thinsp;62.709, 95%CI༚18.687-210.431, \u003cem\u003eP\u0026lt;\u003c/em\u003e0.001) were independent prognostic factors for PFS.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eStage ,platinum resistance and platinum-based chemotherapy are important prognostic factors in patients with ovarian clear cell carcinoma. CA125 levels ,endometriosis, lymph node status and venous thrombosis are also associated with prognosis.\u003c/p\u003e","manuscriptTitle":"Analysis of prognostic-related risk factors in ovarian clear cell carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-29 18:24:52","doi":"10.21203/rs.3.rs-4637467/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d3de3c6-b2c3-41c9-946c-4041a387245c","owner":[],"postedDate":"July 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35117228,"name":"Biological sciences/Cancer/Cancer therapy"},{"id":35117229,"name":"Biological sciences/Cancer/Gynaecological cancer"}],"tags":[],"updatedAt":"2024-11-25T04:53:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-29 18:24:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4637467","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4637467","identity":"rs-4637467","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}