Prognostic Value of Pathologic Chemotherapy Response Score in Patients With Ovarian Cancer After Neoadjuvant Chemotherapy

Abstract

ObjectivesThe aim of the study was to investigate the correlation of chemotherapy response score (CRS) after neoadjuvant chemotherapy (NACT) to treatment outcomes in ovarian cancer (OC).MethodsChemotherapy response score was retrospectively determined on pathology slides of all patients with epithelial OC that had interval debulking surgery (IDS) between 2009–2014. Chemotherapy response score 1 was given when tumor was present and infiltrated by inflammatory cells, CRS 2 when both tumor and regressive chemotherapy changes were present, and CRS 3 when scant tumor was seen within extensive chemotherapy-induced changes. Patients’ characteristics including survival data were collected and compared between CRS groups.ResultsPathology slides of 132 patients were reviewed. Forty-nine patients had CRS 1, 65 had CRS 2, and 18 had CRS 3. Age, stage, and grade were not different across CRS groups. A higher percent of CRS 1 and 2 patients required more than 3 cycles of NACT, whereas CRS 3 patients had higher rates of no residual disease at completion of IDS. Chemotherapy response score 3 group showed the most significant CA125 decrease after NACT (97% decrease, P = 0.016). Kaplan-Meir survival curves showed a significantly longer progression-free survival but not overall survival for patients with CRS 3 (median progression-free survival = 7.5, 12, and 17 months for CRS 1, 2, and 3, respectively, P = 0.012), and this remained statistically significant in both univariate and multivariate analysis. Interobserver reproducibility for CRS was good (weighed κ = 0.762).ConclusionsPatients with CRS 3 have longest progression-free survival and highest CA125 drop after NACT. These parameters have important prognostic value and can be used for clinical decision-making.

Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

“…Although the diameter of metastatic tumors could be reduced using NACT, even to less than 1 cm, the residual tumor tissue may contain cancer stem cells responsible for chemoresistant recurrence [20, 27, 30]. It has been reported that a small subset (5 to 12%) of patients show pathologic complete response (pCR) with no residual tumor cells after NACT and excellent prognosis [31, 32]. Hence, the crucial goal for NACT is to achieve no residual tumor after IDS or even pCR.…”

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

“…This model has been validated, by other groups, as an effective approach in predicting progression-free survival and platinum sensitivity, but data on overall survival are conflicting 7. Moreover, the efficacy of this score in predicting different outcomes has been tested in women with any clinical response to neoadjuvant chemotherapy, including patients with no pathologic response and thus worse survival 8 9…”

A Modified 2 Tier Chemotherapy Response Score (CRS) and Other Histopathologic Features for Predicting Outcomes of Patients with Advanced Extrauterine High-Grade Serous Carcinoma after Neoadjuvant Chemotherapy

“…The 3 tier CRS system was proposed in 2015 and recently recommended by ICCR and CAP in ovarian cancer pathology reporting guidelines [3,7]. Subsequently, several studies have further examined this system and correlated it with prognosis [4,[8][9][10][11][12][13][14]. However, these results showed variable prognostic value, particularly in scoring adnexal samples [8,10,[12][13][14].…”

“…Subsequently, several studies have further examined this system and correlated it with prognosis [4,[8][9][10][11][12][13][14]. However, these results showed variable prognostic value, particularly in scoring adnexal samples [8,10,[12][13][14]. Most studies showed consistent results when using modified 2 tier CRS as compared to the 3 tier CRS in the predicting PFS based on omental tumor sample, while these studies yield conflicting results when using 2 tier or 3 tier CRS predicting OS or using adnexal tumor sample [4,[8][9][10][11][12]14].…”

“…The CRS of omental tumor samples has been reported to correlate with progression-free survival (PFS) [3,4,[7][8][9][10][11][12][13][14], but its predictive value for overall survival (OS) has differed among studies [3,4,[7][8][9][10][11][12]. In addition, a wide range of conflicting results have been seen for the predictive value of CRS in adnexal tumor samples [10,[12][13][14]. Therefore, the clinical usefulness of this CRS system remains to be further examined in a larger clinical cohort.…”