Histopathologic response to neoadjuvant chemotherapy as a prognostic biomarker in tubo-ovarian high-grade serous carcinoma: updated Chemotherapy Response Score (CRS) results

2019 ◽  
Vol 29 (2) ◽  
pp. 353-356 ◽  
Author(s):  
Steffen Böhm ◽  
Nhu Le ◽  
Michelle Lockley ◽  
Elly Brockbank ◽  
Asma Faruqi ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
European Society ◽  
Prognostic Biomarker ◽  
Serous Carcinoma ◽  
Chemotherapy Response ◽  
High Grade ◽  
Cancer Management

ObjectiveThe Chemotherapy Response Scoring (CRS) system was developed to enable reproducible reporting of histologic tumor response in interval debulking specimens following neoadjuvant chemotherapy in advanced stage tubo-ovarian high-grade serous carcinoma. This prognostic biomarker has been included in ovarian cancer pathology reporting guidelines (International Collaboration on Cancer Reporting, College of American Pathologists) and in the upcoming European Society for Medical Oncology-European Society of Gynaecological Oncology (ESMO-ESGO) guidelines for ovarian cancer management. We present follow-up data on the CRS validation initiatives and suggest research with novel therapeutic agents incorporating this biomarker.MethodsThe cohort on whom CRS was originally developed was analyzed after an extended follow-up of an additional 36 months. The CRS histopathologic scoring system was applied to omental sections obtained at interval surgery from all 80 patients. Progression-free and overall survival were re-calculated.ResultsAfter a median follow-up of 4.3 years the CRS score predicted progression-free survival with an HR of 0.39 (95% CI 0.21 to 0.70), p = 0.002 adjusted for age, stage, and debulking status (median 1.08 vs 2.27 years for CRS1/2 vs CRS3). CRS was also predictive of overall survival with an HR of 0.17 (95% CI 0.07 to 0.44), p = 0.0002 adjusted for age, stage, and debulking status (median 2.55 vs 5.47 years for CRS1/2 vs CRS3).ConclusionCRS3 is a reproducible prognostic biomarker for improved progression-free and overall survival in stage 3C or 4 tubo-ovarian high-grade serous carcinoma after neoadjuvant chemotherapy. The score, obtained at interval debulking surgery, can help facilitate research and biomarker driven first-line treatment of patients with advanced ovarian cancer.

Measuring response to neoadjuvant chemotherapy in high-grade serous tubo-ovarian carcinoma: an analysis of the correlation between CT imaging and chemotherapy response score

2019 ◽  
Vol 29 (5) ◽  
pp. 929-934 ◽  
Author(s):  
Meabh McNulty ◽  
Adarsh Das ◽  
Paul A Cohen ◽  
Andrew Dean
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Partial Response ◽  
Stable Disease ◽  
Progression Free Survival ◽  
Chemotherapy Response ◽  
High Grade ◽  
Free Survival ◽  
Radiological Response ◽  
Response Score

IntroductionResponse to neoadjuvant chemotherapy is measured by CT and the decision to proceed with interval surgery is made on the radiological response after two or three cycles of therapy. The Chemotherapy Response Score grades histological tumor regression in omental metastases resected at interval surgery and is associated with progression-free survival and overall survival. It is uncertain whether radiological response is associated with prognosis and whether radiological response predicts Chemotherapy Response Score.To assess if radiological response is associated with progression-free survival and overall survival. Additionally, to investigate whether radiological response predicts the Chemotherapy Response Score.MethodsRetrospective cohort study of patients with high-grade serous ovarian cancer treated with neoadjuvant chemotherapy. Radiological response was assessed by comparing CT imaging at baseline and after neoadjuvant chemotherapy using RECIST (Response Evaluation Criteria In Solid Tumors) and classified as stable disease, partial response, complete response, or progressive disease. Survival analysis was performed using Cox proportional-hazard models and the log-rank test.ResultsA total of 71 patients met the inclusion criteria. Of these, 51 had pre- and post-neoadjuvant chemotherapy CT scans available for analysis. Radiological response was not associated with progression-free survival or overall survival on univariate analysis (stable disease vs partial response; HR for progression-free survival 1.15; 95% CI 0.57 to 2.32; p = 0.690; HR for overall survival 1.19; 95% CI 0.57 to 2.46; p = 0.645). In a multivariate model, radiological response was not associated with either progression-free survival (stable disease vs partial response; HR=1.19; 95% CI 0.498 to 2.85; p = 0.694) or overall survival (stable disease vs partial response; HR=0.954; 95% CI 0.38 to 2.40; p = 0.920). There was a significant association between the Chemotherapy Response Score and radiological response (p = 0.005).DiscussionA partial response and stable disease on radiological assessment after neoadjuvant chemotherapy in women with advanced high-grade serous ovarian cancer were not associated with survival, despite having a correlation with the Chemotherapy Response Score.

Prognostic significance of obesity in high-grade serous carcinoma of the ovary

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16528-e16528 ◽  
Author(s):  
M. Schlumbrecht ◽  
D. Urbauer ◽  
D. Gershenson ◽  
R. Broaddus
Keyword(s):  
Ovarian Cancer ◽  
Body Mass Index ◽  
Overall Survival ◽  
Body Mass ◽  
Neoadjuvant Treatment ◽  
The United States ◽  
Wilcoxon Test ◽  
Serous Carcinoma ◽  
Low Grade ◽  
High Grade

e16528 Background: Obesity is an epidemic public health problem in the United States. In gynecologic oncology, obesity is an established risk factor for endometrial cancer. However, its role in the pathogenesis and survival in ovarian cancer is debated. Recent studies have attempted to elucidate a possible relationship, but variations in design and heterogeneity in patient characteristics make it difficult to draw definitive conclusions. The purpose of our study was to determine if body mass index at the time of treatment initiation for high grade serous ovarian carcinoma has an effect on patient outcome. Methods: Nine-hundred four patients treated for ovarian cancer at M.D. Anderson Cancer Center were identified between 2002 and 2007. Patients were excluded for low grade or non-serous histology, neoadjuvant treatment, or if presenting with recurrent disease. Clinicopathologic data were extracted by retrospective chart review. Patients were stratified by body mass index (BMI) as normal (BMI<25), overweight (BMI 25-<30), or obese (BMI>30). All were treated with primary cytoreduction and standard platinum/taxane chemotherapy. Chemotherapy was dosed using adjusted body weights. Outcomes included time to recurrence, overall survival, success of surgical debulking, and chemotherapeutic toxicities. Statistical analysis was performed using Fisher's exact test, Wilcoxon test, and Kaplan-Meier estimates. Results: A total of 127 patients were included for analysis. Patients were followed for a mean of 37 months (range 3–86 months). Twenty-one patients were obese (16.5%), and 35 were overweight (27.5%). Diabetes was more prevalent in the obese cohort (p = 0.0038). There was a trend towards greater likelihood of suboptimal debulking in obese patients, but this did not reach statistical significance (p = 0.06). BMI had no effect on recurrence-free survival (HR 0.69 [CI 0.39–1.23], p = 0.21) or overall survival (HR 0.95 [CI 0.68–2.43], p = 0.91). There was no difference in chemotherapy side effects or chemoresistance across BMI strata. Conclusions: Body mass index has no effect on survival in women with high grade serous ovarian cancer. Effectively managing comorbidities and ensuring adequate chemotherapy dosing in the obese patient is crucial for optimizing outcome. No significant financial relationships to disclose.

Genomic instability (GI) score post-neoadjuvant chemotherapy (NACT) to predict overall survival (OS) in high grade ovarian cancer (HGSOC).

2016 ◽  
Vol 34 (15_suppl) ◽  
pp. 5573-5573
Author(s):  
Aurelie Auguste ◽  
Elena Cojocaru ◽  
Soizick Mesnage ◽  
Audrey Le Formal ◽  
Romy chen-Min-Tao ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Genomic Instability ◽  
High Grade

scholarly journals 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

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 704
Author(s):  
Yanping Zhong ◽  
Jinsong Liu ◽  
Xiaoran Li ◽  
Shannon N. Westin ◽  
Anais Malpica ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Prognostic Significance ◽  
Clinical Information ◽  
Progression Free Survival ◽  
Serous Carcinoma ◽  
Chemotherapy Response ◽  
High Grade ◽  
Entire Cohort ◽  
The Impact ◽  
Response Score

Background: The impact of chemotherapy response score (CRS) on prognosis has varied among studies. We addressed the prognostic significance of CRS and the prognostic value of previously undescribed histologic features using a cohort of 245 patients. Methods: Retrospective study in patients with advanced extrauterine high-grade serous carcinomas treated with neoadjuvant chemotherapy followed by interval tumor reductive surgery from 1990 to 2018 in our hospital. Gynecologic pathologists assessed tumor CRS and other histologic features. Clinical information was collected, and multivariate analyses were conducted. Results: A modified 2 tier CRS (CRS 1/2 versus CRS 3) was significantly associated, independent of scoring site (omental versus adnexal), with overall survival (OS) (omentum, p = 0.018; adnexa, p = 0.042; entire cohort, p = 0.002) and progression-free survival (PFS) (p = 0.021, p = 0.035, and p = 0.001, respectively). On multivariate survival analysis, 2 tier CRS, oncocytic change, inflammation, and desmoplasia were significant for OS (p = 0.034, p = 0.020, p = 0.007, and p = 0.010, respectively). Likewise, 2 tier CRS, inflammation, and desmoplasia were significant for PFS (p = 0.012, p = 0.003, p = 0.011, respectively). Conclusions: The modified 2 tier CRS was significantly associated with survival, independent of scoring site. Additional histologic features including oncocytic change, inflammation, and desmoplasia can also predict patient outcomes.

scholarly journals Analysis of the outcome of patients with stage IV uterine serous carcinoma mimicking ovarian cancer

2019 ◽  
Author(s):  
Murad Al-Aker ◽  
Karen Sanday ◽  
James Nicklin
Keyword(s):  
Ovarian Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Cytoreductive Surgery ◽  
Stage Iv ◽  
Serous Carcinoma ◽  
Optimal Cytoreduction ◽  
Uterine Serous Carcinoma ◽  
Interval Cytoreduction

ABSTRACTObjectivesTo identify clinicopathological factors that might influence survival in patients with stage IV uterine serous carcinoma, and to compare survival outcomes in patients with stage IV uterine serous carcinoma managed with neoadjuvant chemotherapy followed by interval cytoreduction (with or without adjuvant chemotherapy), primary cytoreductive surgery followed by adjuvant chemotherapy.MethodsA retrospective cohort study of all patients with stage IV Uterine serous carcinoma treated between 2005 and 2015 within a regional cancer centre. Progression-free and overall survival rates were calculated using the Kaplan–Meier method.ResultsOf 50 women with stage IV uterine serous carcinoma who met inclusion criteria, 37 underwent primary cytoreductive surgery, nine received neoadjuvant chemotherapy with planned interval cytoreductive surgery and four received palliative care only. A pre-treatment diagnosis of stage IV uterine serous carcinoma was made for only 45.9% of the primary cytoreductive surgery group and 56.6% of the neoadjuvant chemotherapy group, with advanced ovarian cancer the most common preoperative misdiagnosis. Median follow up was 19 months. Median overall survival was 27 months for the primary cytoreductive surgery group, 20 months for the neoadjuvant chemotherapy group and two months for the palliative care group. Optimal cytoreduction was achieved in 67.6% of the primary cytoreductive surgery group and 87.5% of the neoadjuvant chemotherapy group who underwent interval cytoreduction. Optimal cytoreduction was associated with improvement in overall survival, compared with suboptimal cytoreduction (36 versus 15 months; P=0.16). Adjuvant chemotherapy was associated with significantly higher overall survival compared with no adjuvant chemotherapy (36 versus four months; P<0.05). Median overall survival was 16 months for those with pure uterine serous carcinoma (n=40), compared with 32 months for those with mixed histopathology (n=10).ConclusionStage IV uterine serous carcinoma can mimic advanced ovarian cancer. It carries a poor prognosis, which is worse for pure uterine serous carcinoma than for mixed-type endometrial adenocarcinoma. Neoadjuvant chemotherapy followed by interval cytoreduction and adjuvant chemotherapy seems to be a safe option, with an increased rate of optimal cytoreduction and comparable overall survival, compared with primary cytoreductive surgery. Adjuvant chemotherapy significantly improves survival in all groups.Primary objectiveTo analyse the clinicopathological factors that might influence the progression-free survival and overall survival in patients with stage IV uterine serous carcinoma treated at Queensland Centre for Gynecological cancer.Secondary objectiveTo compare the survival outcomes of patients with stage IV uterine serous carcinoma treated with neoadjuvant chemotherapy and interval cytoreduction, with those treated with primary cytoreductive surgery followed by adjuvant chemotherapy and patients who received palliative care only.PRECISOptimal cytoreduction and adjuvant chemotherapy improved survival in stage IV uterine serous carcinoma. Neoadjuvant chemotherapy was feasible and safe. Patients with microscopic disease have similar poor prognosis.HIGHLIGHTSPure uterine serous carcinoma carries a worse prognosis compared to mixed uterine serous carcinomaOptimal cytoreduction and adjuvant chemotherapy improve survival in Stage IV uterine serous carcinomaNeoadjuvant chemotherapy is feasible and a safe option in the management of stage IV uterine serous carcinoma

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