Objective  To investigate the changes of coagulation, fibrinolysis and platelet indexes in ovarian cancer patients before and after neoadjuvant chemotherapy, and to analyze the risk relationship between relevant indexes before treatment and the effect of neoadjuvant chemotherapy (NACT).

Methods  Patients with ovarian cancer admitted to Xi'an Fengcheng Hospital, from March 2020 to March 2023 were included as the ovarian cancer group, and female  patients who underwent physical examination in the same period were selected as the control group according to a 2 ∶ 1 ratio. Prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), fibrinogen (FIB), platelet distribution width (PDW), platelet hematocrit (PCT), platelet (PLT) and mean platelet volume (MPV) were compared between the two groups. The changes of these indexes were compared before and after NACT, at different clinical stages and before and after NACT with different efficacy effects. Moreover, they were divided into effective and ineffective groups according to their treatment efficacy. Logistic regression was used to explore the relationship between the parameters and NACT efficacy; receiver operating characteristic curve was drawn to predict the value of NACT efficacy.

Results  A total of 144 patients were included, with 96 cases in the ovarian cancer group and 48 in the control group. The FIB, PLT and MPV of patients in the ovarian cancer group were higher than those in the control group (P<0.05). The PT, TT, APTT, FIB and PLT of ovarian cancer patients after NACT were lower than those before NACT (P<0.05). FIB and PLT of stage Ⅱ patients were lower than those of stage Ⅲ before and after NACT, and the PT, TT, APTT, FIB and PLT of the effective group were lower than those of the ineffective group before and after NACT, and the PT, TT, APTT, FIB and PLT of the two groups after NACT were lower than those before NACT (P<0.05). Multivariate Logistic regression analysis indicated that high PT, TT, APTT, FIB and PLT before NACT were independent risk factors for NACT ineffectiveness (P<0.05). The area under the curve of PT, TT, APTT, FIB and PLT before NACT to predict the effect of NACT were 0.713 (sensitivity of 80.95%, specificity of 69.33%), 0.756 (sensitivity of 71.43%, specificity of 82.67%) and 0.787 (sensitivity of 76.19%, specificity of 70.67%), 0.727 (sensitivity of 71.43%, specificity of 84.00%), 0.794 (sensitivity of 80.95%, specificity of 76.00%), respectively.

Conclusion  Changes in coagulation and fibrinolytic function and platelet parameters in ovarian cancer patients after NACT are associated with clinical stages and NACT effect. High levels of PT, TT, APTT, FIB and PLT before NACT are important reasons affecting NACT effect. Constructing the risk prediction model of NACT efficacy in ovarian cancer patients based on the above five parameters can provide a reference for clinical practice.

1.宋涛涛, 李梦一, 袁冰凡, 等. 小檗碱通过抑制ALDH1活性降低卵巢癌细胞药物转运蛋白的表达逆转紫杉醇耐药[J]. 中国药师, 2022, 25(7): 1144-1150. [Song  TT, Li  MY, Yuan BF, et al. Berberine reverses paclitaxel resistance by inhibiting the activity of ALDH1 and reducing the expression of drug transporters in ovarian cancer cells[J]. China Pharmacist, 2022, 25(7): 1144-1150.] DOI: 10.19962/j.cnki. issn1008-049X.2022.07. 003.

2.朱秀红, 毛翠玉, 张燕, 等. 卵巢癌新辅助化疗的研究进展[J]. 现代妇产科进展, 2023, 32(11): 865-869. [Zhu XH, Mao CY, Zhang Y, et al. Research progress on neoadjuvant chemotherapy for ovarian cancer[J]. Progress in Modern Obstetrics and Gynecology, 2023, 32(11): 865-869.] DOI: 10.13283/j. cnki. xdfckjz.2023.11.031.

3.胡莎莎, 王晓燕, 刘畅, 等. 18F-FDG PET/CT在上皮性卵巢癌复发诊断价值的Meta分析[J]. 中国循证医学杂志, 2023, 23(5): 528-533. [Hu SS, Wang XY, Liu Chang, et al. Meta analysis of the diagnostic value of 18F-FDG PET/CT in the recurrence of epithelial ovarian cancer[J]. Chinese Journal of Evidence Based Medicine, 2023, 23(5): 528-533.] DOI: 10.7507/1672-2531.202206069.

4.朱连成, 林蓓. 新辅助化疗对卵巢癌肿瘤细胞减灭术手术结局的影响[J]. 中国实用妇科与产科杂志, 2023, 39(7): 706-711. [Zhu LC, Lin B. The influence of neoadjuvant chemotherapy on the surgical outcome of ovarian cancer tumor reduction surgery[J]. Chinese Journal of Practical Gynecology and Obstetrics, 2023, 39(7): 706-711.] DOI: 10.19538/j. fk2023070108.

5.Liu C, Zhang Y, Li X, et al. Ovarian cancer-specific dysregulated genes with prognostic significance: scRNA-Seq with bulk RNA-Seq data and experimental validation[J]. Ann NY Acad Sci, 2022, 1512(1): 154-173. DOI: 10.1111/nyas.14748.

6.Timmermans M, Van der HO, Sonke GS, et al. The prognostic value of residual disease after neoadjuvant chemotherapy in advanced ovarian cancer: a systematic review[J]. Gynecol Oncol, 2019 ,153(2): 445-451. DOI: 10.1016/j.ygyno.2019.02.019.

7.马会明, 张翔, 何品芳, 等. 恶性肿瘤患者凝血功能变化的研究进展[J]. 山东医药, 2020, 60(28): 112-115. [Ma HM, Zhang X, He PF, et al. Research progress on changes of coagulation function in patients with malignant tumor[J]. Shandong Medicine, 2019, 60(28): 112-115.] DOI: 10.3969/j.issn.1002-266X.2020.28.031.

8.汪敏, 于鹏跃, 王言, 等. 外周血凝血指标、血小板计数和NLR检测对恶性肿瘤患者治疗前机体凝血状态的评估价值[J]. 吉林大学学报（医学版）, 2022, 48(1): 203-210. [Wang M, Yu PY, Wang Y, et al. Evaluation value of peripheral blood coagulation index, platelet count and NLR detection on coagulation status of patients with malignant tumors before treatment[J]. Journal of Jilin University (Medical Edition), 2022, 48(1): 203-210.] DOI: 10.13481/j.1671.

9.王珊珊, 张立. 血小板参数在乳腺癌患者早期诊断中的价值研究[J]. 现代肿瘤医学, 2019, 27(6): 985-987. [Wang SS, Zhang L. The value of platelet parameters in the early diagnosis of breast cancer patients[J]. Modern Oncology Medicine, 2019, 27(6): 985-987.] DOI: 10.3969/j.issn.1672-4992.2019.06.019.

10.沈坤炜, 李宏为, 主编. 乳腺癌临床诊治实用手册[M]. 上海: 上海科学技术文献出版社, 2013: 134.

11.Harrison RF, Cantor SB, Sun CC, et al. Cost-effectiveness of laparoscopic disease assessment in patients with newly diagnosed advanced ovarian cancer[J]. Gynecol Oncol, 2021, 161(1): 56-62. DOI: 10.1016/j.ygyno.2021.01.024.

12.Fleming ND, Westin SN, Rauh-Hain JA, et al. Factors associated with response to neoadjuvant chemotherapy in advanced stage ovarian cancer[J]. Gynecol Oncol, 2021, 162(1): 65-71. DOI: 10.1016/j.ygyno.2021.04.002.

13.贾琳钰, 王辉, 姜苏娟, 等. 血栓弹力图评估妇科恶性肿瘤患者凝血状态的研究[J]. 河北医药, 2020, 42(6): 837-840. [Jia LY, Wang H, Jiang SJ, et al. Study on thromboelastography to evaluate coagulation status in patients with gynecological malignant tumor[J]. Hebei Medicine, 2019, 42(6): 837-840.] DOI: CNKI:SUN:HBYZ. 0.2020-06-008.

14.朱小双, 孙轶华. 血小板在肿瘤转移中的研究进展[J]. 中国实验诊断学, 2020, 24(3): 522-525. [Zhu XS, Sun YH. Research progress of platelets in tumor metastasis[J]. Chinese Journal of Experimental Diagnostics, 2019, 24(3): 522-525.] DOI: CNKI:SUN:ZSZD.0.2020-03-051.

15.管俊锋, 佘思齐, 解千歆, 等. 血小板与肿瘤物质交换的研究进展[J]. 中国病理生理杂志, 2023, 39(5): 910-918. [Guan JF, She SQ, Xie QX, et al. Research progress of platelet exchange with tumor materials[J]. Chinese Journal of Pathophysiology, 2019, 39(5): 910-918.] DOI: 10.3969/j.issn.1000-4718.2023.05.017.

16.赖晓雪, 王硕, 闫鑫杨, 等. 基于血小板的肿瘤靶向治疗策略与反思[J]. 药学学报, 2021, 56(4): 1025-1034. [Lai XX, Wang S, Yan XY, et al. Platelet-based tumor targeted therapy strategy and reflection[J]. Chinese Journal of Medicine, 2019, 56(4): 1025-1034.] DOI: 10.16438/j.0513-4870.2020-1903.

17.李婧, 梁何俊, 隋鑫, 等. Ⅱ/Ⅲ期胃癌术后患者预后预测模型的建立[J]. 郑州大学学报(医学版), 2022, 57(2): 220-227. [Li J, Liang HJ, Sui X, et al. Establishment of a prognostic prediction model for patients with stage Ⅱ/Ⅲ gastric cancer after surgery[J]. Journal of Zhengzhou University (Medical Edition), 2022, 57(2): 220-227.] DOI: 10.13705/j. issn.1671-6825.2021.05.052.

18.徐志刚, 卢霞, 龚晓霖. CA125、Fib、DD在卵巢癌化疗疗效评估中的价值[J]. 检验医学, 2022, 37(11): 1104-1105. [Xu ZG, Lu X, Gong XL. The value of CA125, Fib and DD in the evaluation of chemotherapy effect of ovarian cancer[J]. Laboratory Medicine, 2022, 37(11): 1104-1105.] DOI: 10.3969/j.issn.1673-8640.2022. 011.021.

19.冯世香, 张春艳, 王光慧. 术前MPV/PLT与LMR对卵巢癌患者预后评估的意义[J]. 湖南师范大学学报(医学版), 2022, 19(2): 176-180. [Feng SX, Zhang CY, Wang GH. Significance of preoperative MPV/PLT and LMR in prognosis assessment of patients with ovarian cancer[J]. Journal of Hunan Normal University (Medical Edition), 2022, 19(2): 176-180.] DOI: 10.3969/j.issn.1673-016X.2022.02.049.

20.夏兰兰, 颜丙芳, 赵红梅, 等. 卵巢癌患者凝血功能指标检测结果分析[J]. 检验医学与临床, 2021, 18(9): 1294-1296. [Xia LL, Yan BF, Zhao HM, et al. Analysis of detection results of coagulation function index in patients with ovarian cancer[J]. Laboratory Medicine & Clinic, 2019, 18(9): 1294-1296.] DOI: 10.3969/j.issn.1672-9455.2021.09.030.

21.邵树军, 祁欣, 刘宗健, 等. 肿瘤患者凝血功能异常时凝血因子活性变化及临床意义[J]. 中华医学杂志, 2021, 101(47): 3845-3849. [Shao SJ, Qi X, Liu ZJ, et al. Changes of coagulation factor activity and its clinical significance in patients with tumor coagulation dysfunction[J]. Chinese Medical Journal, 2019, 101(47): 3845-3849.] DOI: 10.3760/cma.j.cn112137-20211018-02300.

22.于玉芳, 沈婧. 肿瘤患者血清IL-6、TNF-α、CRP水平与凝血功能的相关性分析[J]. 标记免疫分析与临 床, 2020, 27(1): 19-22, 31. [Yu YF, Shen J. Correlation analysis of serum IL-6, TNF-α, CRP levels and coagulation function in tumor patients[J]. Marker Immunoassay and Clinical Analysis, 2020, 27(1): 19-22, 31.] DOI: 10.11748/bjmy.issn.1006-1703.2020.01.005.

23.蒋丽君, 张伟, 钮晖, 等. 379例晚期恶性肿瘤患者凝血功能的改变及其临床意义[J]. 宁夏医科大学学报, 2019, 41(7): 681-684. [Jiang LJ, Zhang W, Niu H, et al. Changes of coagulation function and its clinical significance in 379 patients with advanced malignant tumors[J]. Journal of Ningxia Medical University, 2019, 41(7): 681-684.] DOI: 10.16050/j.cnki.issn1674-6309.2019.07.007.