External validation of a 'response score' after neoadjuvant chemotherapy in patients with high-grade serous ovarian carcinoma with complete clinical response

Abstract

ObjectivesThe chemotherapy response score (CRS) has been developed for measuring response to neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma. This study aimed to validate the ability of this three-tier scoring system of pathologic response on omental specimens to determine prognosis in a subgroups of patients who had clinical complete response to neoadjuvant chemotherapy.MethodsThis was a retrospective study, conducted in women receiving interval debulking surgery at the Division of Gynecologic Oncology, between December 2007 and April 2017. Inclusion criteria were: high-grade serous ovarian cancer, FIGO stage IIIC/IV, platinum-based neoadjuvant chemotherapy, and clinical complete response after neoadjuvant chemotherapy (normalization in CA125 levels, disappearance of all target and non-target lesions according to RECIST 1.1). CRS was defined by a single pathology review and classified as previously reported: CRS1, no or minimal tumor response with fibroinflammatory changes limited to a few foci ranging from multifocal or diffuse regression-associated fibroinflammatory changes with viable tumor in sheets, or nodules to extensive regression-associated fibroinflammatory changes with multifocal residual tumor; CRS2, appreciable tumor response with viable tumor readily identifiable; and CRS3, complete absence of tumor or nodules with maximum size of 2 mm. CRS was analyzed according to clinical variables and survival.ResultsA total of 108 patients were eligible for analysis. The average age was 65 (range 36–85) years. A total of 91 (84.3%) patients had stage IIIC disease and 17 (15.7%) patients had stage IV disease. No statistically significant differences were observed in terms of age, FIGO stage, CA125 serum levels, type of chemotherapy schedules, and number of cycles between the three groups. Patients in the CRS3 group had a longer median progression-free survival (25.8 months) compared with CRS2 or CRS 1 (20.3 vs 17.4 months, respectively; p=0.001). Median overall survival was 68.9 months for CRS3, 35.0 months for CRS2, and 45.9 months for CRS1 (p=0.034).ConclusionComplete or near-complete pathologic response assessed in the omental specimens of advanced epithelial ovarian carcinoma patients after neoadjuvant chemotherapy (CRS3) is predictive of prolonged progression-free and overall survival. In particular, this is true in women with a clinical complete response.

Decrease in Neutrophil-to-Lymphocyte Ratio during Neoadjuvant Chemotherapy as a Predictive and Prognostic Marker in Advanced Ovarian Cancer

“…In patients who underwent interval debulking surgery, chemotherapy response scores (CRS) were assigned to omental and adnexal metastases, and categorized as no/minimal (CRS1), partial (CRS2), and complete/near-complete (CRS3) response to neoadjuvant chemotherapy according to Bohm et al [ 31 ]. In brief, CRS1 corresponds to no or minimal tumor response (no or minimal regression-associated fibroinflammatory changes limited to a few foci), cases in which it is difficult to decide between regression and tumor-associated desmoplasia or inflammatory cell infiltration; CRS2 means appreciable tumor response with viable tumor readily identifiable, ranging from multifocal or diffuse regression-associated fibroinflammatory changes with viable tumor in sheets, streaks, or nodules to extensive regression-associated fibroinflammatory changes with multifocal residual tumors; and CRS3 corresponds to complete absence of tumor cells or individual cells, cell groups, or nodules with maximum size of 2 mm [ 32 ].…”

Identification of Ovarian Cancer Patients Most Likely to Achieve Chemotherapy Response Score 3 Following Neoadjuvant Chemotherapy: Development of a Predictive Nomogram

“…The CRS system is the only method that is recommended in ESMO-ESGO guidelines for ovarian cancer patients to predict PFS and OS following NACT-IDS ( 3 ). Its reproducibility and accuracy have been validated in numerous studies ( 10 – 13 , 15 ). The omental response to NACT that was graded with the scoring system was reported to be even more important than debulking status for the prognosis of patients.…”

The added value of CA125 normalization before interval debulking surgery to the chemotherapy response score for the prognostication of ovarian cancer patients receiving neoadjuvant chemotherapy for advanced disease

“…In the 2019 European Society for Medical Oncology (ESMO) ovarian cancer guidelines, a three-tiered chemotherapy response score (CRS) system was recommended for patients receiving NACT to evaluate tumor response and predict prognosis [11]. Since its description, the CRS system has been independently assessed in many studies [12][13][14][15][16][17]. Currently, it is considered an accurate and highly reproducible method to predict survival outcomes for patients with tubo-ovarian high-grade serous carcinoma (HGSC) [11].…”