217 The impact of chemotherapy response score and lymphocytic infiltration in patients with ovarian cancer treated with neoadjuvant chemotherapy

Abstract Background Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is the recommended approach in patients with advanced epithelial ovarian cancer (EOC). However, most patients eventually relapse despite the initial high response rate to chemotherapy. Neutrophil-to-lymphocyte ratio is a well-known biomarker that reflects severe inflammation, critical illness, and mortality in various diseases. Chemotherapy response score (CRS) and neutrophil-to-lymphocyte ratio (NLR) have been identified as potential biomarkers of platinum resistance and disease prognosis. We retrospectively evaluated 132 patients with stage IIIc or IV ovarian/fallopian tube/primary peritoneal cancer who had received NACT followed by IDS from 01/01/2003 to 31/12/2018. CRS was assessed on omental specimens collected from IDS according to ICCR guidelines. Results Median age was 64.57 years (SD: 9.72; range 39.2–87.1). Most ovarian tumors were serous epithelial (90.9%; 120/132). An elevated NLR (defined as > 3) was observed in 72% (95/132) of patients in contrast with 28% (37/132) of patients characterized by low NLR status. Median PFS (mPFS) and median overall survival (mOS) were 13.05 months (95% CI: 11.42–14.67)) and 34.69 months (95% CI: 23.26–46.12) respectively. In univariate analysis, CRS3 score was significantly associated with prolonged mPFS (CRS1/2: 12.79 months vs CRS3: 17.7 months; P = 0.008). CRS score was not associated with mOS (P = 0.876). High NLR was not significantly associated with mPFS (P = 0.128), however it was significantly associated with poor mOS (P = 0.012). In multivariate analysis, only performance of surgery maintained its statistical significance with both PFS (P = 0.001) and OS (P = 0.008). Conclusion NLR could serve as a useful predictor of OS but not PFS in ovarian cancer patients receiving NACT. In accordance with our previous study, CRS score at omentum was found to be associated with PFS but not OS in ovarian cancer patients treated with NACT and IDS.

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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

Journal of Cancer ◽

10.7150/jca.52711 ◽

2021 ◽

Vol 12 (3) ◽

pp. 946-953

Author(s):

Wei-feng Liang ◽

Li-juan Wang ◽

Hui Li ◽

Chang-hao Liu ◽

Miao-fang Wu ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Cancer Patients ◽

Advanced Disease ◽

Added Value ◽

Chemotherapy Response ◽

Debulking Surgery ◽

Interval Debulking Surgery ◽

Response Score

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Impact of Ki-67 Labeling Index on Prognostic Significance of the Chemotherapy Response Score in Women With Tubo-ovarian Cancer Treated With Neoadjuvant Chemotherapy

International Journal of Gynecological Pathology ◽

10.1097/pgp.0000000000000706 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Michelle Heayn ◽

Lauren B. Skvarca ◽

Li Zhu ◽

Robert P. Edwards ◽

Alexander B. Olawaiye ◽

...

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Prognostic Significance ◽

Labeling Index ◽

Chemotherapy Response ◽

Ki 67 ◽

Response Score

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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 ◽

10.3390/cancers13040704 ◽

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.

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

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001366 ◽

2018 ◽

Vol 28 (9) ◽

pp. 1676-1682 ◽

Cited By ~ 6

Author(s):

Nadav Michaan ◽

Woo Yoo Chong ◽

Na Young Han ◽

Myong Cheol Lim ◽

Sang Yoon Park

Keyword(s):

Ovarian Cancer ◽

Neoadjuvant Chemotherapy ◽

Survival Data ◽

Prognostic Value ◽

Clinical Decision Making ◽

Residual Disease ◽

Progression Free Survival ◽

Chemotherapy Response ◽

Free Survival ◽

Response Score

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.

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