Analysis of patient's germline BRCA gene mutation
A total of 82 patients with epithelial ovarian cancer were enrolled, and 25 cases of BRCA1/2 pathogenic mutations were found, with a total mutation rate of 30.48%. Among them, 17 cases of BRCA1 pathogenic mutation, the mutation rate was 20.73%. There were 8 cases of BRCA2 pathogenic mutation, the mutation rate was 9.75%. A total of 13 pathogenic mutations in BRCA1 were detected, including c.2160delA, c.3770_3771delAG, c.5470_5477delATTGGGCA, c.3255_3259del (p.Leu1086fs), c.3294del (p.Pro1099fs), c.4782del (p.Ser1595fs), c.587dupA (p.Tyr196fs), c.4065_4068delTCAA, c.4132delG these 9 sites are frame-shift mutations, followed by c.3967C>G, c.1115G>A, c.4801A>T, C.6528C >G is a missense mutation. A total of 7 pathogenic mutations were detected in BRCA2, c.1495C>T, c.6528C>G, c.2041G>A, c.4593dupA were missense mutations, c.1499del (p.Gly500fs), c.3770_3771dell (p.Glu1257fs), c.6405_6409delCTTAA were frame-shift mutations. The clinical significance of c.4132delG locus and C.6528C>G locus is unknown and there is no literature report, which may have potential research value (Table 1).
Demographic and clinical information
Detailed information concerning age, meno information, pathological type, FIGO stage et al. are shown in Table 2. Our results showed that the 82 cases were all patients with epithelial ovarian cancer, including 12 (14.6%) cases of stage I-II, 70 (86.4%) cases of stage III-IV; among the pathological factors, 74 (90.2%) cases of serous cancer, 8 (9.8%) cases of non-serous cancer, specifically: 5 cases of clear cell carcinoma, 3 cases of endometrioid carcinoma; 42 cases of neoadjuvant chemotherapy patients, all of whom were stage IIIC and IV. After follow-up, 63 (76.8%) of 82 patients were platinum-sensitive; 19 (23.2%) were platinum-resistant or refractory; confirmed by imaging or postoperative pathology, 34 (41.5%) patients with lymph node metastasis; 49 (59.8%) patients had greater omental metastasis; 31 (37.8%) patients had diaphragmatic top metastasis; 21 (25.6%) patients had colorectal invasion; preoperative CA125 value>500 U/mL 51 (62.2%) cases. There was no significant difference in clinical factors such as age of onset and menstrual status between the two groups of patients (P>0.05), and they were comparable. The pathogenic mutation status of BRCA1/2 gene is related to pathological type, platinum sensitivity, neoadjuvant chemotherapy, and the difference between groups is statistically significant (P<0.05) (Table 2). Among the patients undergoing germline BRCA mutation gene detection, a total of 42 patients were treated with Olaparib orally, and 40 patients were selected as the control group.
Olaparib status and QOL
All 82 patients completed the QLQ C30 and QLQ OV28 questionnaires at the time of initial enrollment. Table 3 shows the QOL scores of patients with different Olaparib strata. At the early stage of the enrollment survey, the overall health score of QLQ-C30 was very low. The lowest scores are social function and cognitive function. In terms of symptoms, financial difficulties are the most serious. The QLQ-OV28 sexual score was the lowest. Among these 44/82 patients, 35/71 (86.5%) reported complete loss of interest in sex, and the remaining 7/11 (13.4%) reported low interest in sex. A total of 38/75 patients (91.4%) reported no sexual activity at all. Only 6/11 patients reported that they had sexually activity, but all said that they rarely experienced sexual enjoyment. We used linear regression models to establish the correlation between Olaparib status and QOL at the time of initial enrollment (Table 3).
Our results showed that patients without Olaparib status fared worse with respect to physical functioning (P = 0.038), role functioning (P = 0.010), cognitive functioning (P = 0.005), emotional functioning (P = 0.006) and social functioning (P < 0.0001). The results showed that patients without Olaparib performed worse in terms of physical function (P = 0.038), role function (P = 0.010), cognitive function (P = 0.005), emotional function (P = 0.006), and social function (P < 0.0001).
Patients suffered more severe symptoms of constipation (P = 0.001), poor body image (P = 0.003), poor attitude toward treatment and disease (P < 0.0001), and other chemotherapy side effects (P = 0.020). They suffered from more severe constipation symptoms (P = 0.001), poor body image (P = 0.003), poor attitudes towards treatment and disease (P < 0.0001), and other side effects of chemotherapy (P = 0.020).
There were 82 patients that completed both the baseline and follow-up surveys and changes in QOL outcomes were determined for this group. 42 patients completed the baseline and follow-up surveys, and determined the changed outcomes in QOL results for this group.
Our research results show that the physical, role function and cognitive function as well as the range of nausea and vomiting, insomnia, loss of appetite and other side-effects were significantly worsened (Table 3). Then, we identified patients with deteriorating QOL who had lower scores in terms of functional domain, global health, and sexual function; or increased other symptom domains during follow-up (Table 3).
We applied a logistic regression model to determine whether Olaparib status can predict the risk of QOL deterioration. Our results show that patients without Olaparib had a significantly higher risk of deterioration in their quality of life in terms of physical function (P = 0.001), role function (P = 0.0140), emotional function(P = 0.021), pain (P = 0.010) , and financial difficulties (P = 0.003) (Table 3).