Chemotherapy response score after neoadjuvant chemotherapy in ovarian advanced high-grade serous carcinoma correlates with peritoneal cancer index

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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Chemotherapy Response Score: Development and Validation of a System to Quantify Histopathologic Response to Neoadjuvant Chemotherapy in Tubo-Ovarian High-Grade Serous Carcinoma

Journal of Clinical Oncology ◽

10.1200/jco.2014.60.5212 ◽

2015 ◽

Vol 33 (22) ◽

pp. 2457-2463 ◽

Cited By ~ 99

Author(s):

Steffen Böhm ◽

Asma Faruqi ◽

Ian Said ◽

Michelle Lockley ◽

Elly Brockbank ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Scoring System ◽

Validation Cohort ◽

Serous Carcinoma ◽

Chemotherapy Response ◽

High Grade ◽

Debulking Surgery ◽

Interval Debulking Surgery ◽

Response Score ◽

Response To Neoadjuvant Chemotherapy

Purpose To develop and validate a histopathologic scoring system for measuring response to neoadjuvant chemotherapy in interval debulking surgery specimens of stage IIIC to IV tubo-ovarian high-grade serous carcinoma. Patients and Methods A six-tier histopathologic scoring system was proposed and applied to a test cohort (TC) of 62 patients treated with neoadjuvant chemotherapy and interval debulking surgery. Adnexal and omental sections were independently scored by three pathologists. On the basis of TC results, a three-tier chemotherapy response score (CRS) system was developed and applied to an independent validation cohort of 71 patients. Results The initial system showed moderate interobserver reproducibility and prognostic stratification of TC patients when applied to the omentum but not to the adnexa. Condensed to a three-tier score, the system was highly reproducible (kappa, 0.75). When adjusted for age, stage, and debulking status, the score predicted progression-free survival (PFS; score 2 v 3; median PFS, 11.3 v 32.1 months; adjusted hazard ratio, 6.13; 95% CI, 2.13 to 17.68; P < .001). The three-tier CRS system applied to omental samples from the validation cohort showed high reproducibility (kappa, 0.67) and predicted PFS (CRS 1 and 2 v 3: median, 12 v 18 months; adjusted hazard ratio, 3.60; 95% CI, 1.69 to 7.66; P < .001). CRS 3 also predicted sensitivity to first-line platinum therapy (94.3% negative predictive value for progression < 6 months). A Web site was established to train pathologists to use the CRS system. Conclusion The CRS system is reproducible and shows prognostic significance for high-grade serous carcinoma. Implementation in international pathology reporting has been proposed by the International Collaboration on Cancer Reporting, and the system could potentially have an impact on patient care and research.

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Improvement of radiological disease on CT after neoadjuvant chemotherapy may not correlate with chemotherapy response score (CRS) in advanced tubo-ovarian high-grade serous ovarian carcinoma

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.04.266 ◽

2019 ◽

Vol 154 ◽

pp. 110-111 ◽

Cited By ~ 1

Author(s):

R. Sugrue ◽

K. James ◽

W.B. Growdon ◽

R.M. Clark ◽

M.G. del Carmen ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Ovarian Carcinoma ◽

Chemotherapy Response ◽

High Grade ◽

Serous Ovarian Carcinoma ◽

Response Score

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Pathological chemotherapy response score is prognostic in tubo-ovarian high-grade serous carcinoma: A systematic review and meta-analysis of individual patient data

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.04.679 ◽

2019 ◽

Vol 154 (2) ◽

pp. 441-448 ◽

Cited By ~ 17

Author(s):

Paul A. Cohen ◽

Aime Powell ◽

Steffen Böhm ◽

C. Blake Gilks ◽

Colin J.R. Stewart ◽

...

Keyword(s):

Systematic Review ◽

Individual Patient Data ◽

Meta Analysis ◽

Patient Data ◽

Serous Carcinoma ◽

Chemotherapy Response ◽

High Grade ◽

Response Score

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

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000222 ◽

2019 ◽

Vol 29 (5) ◽

pp. 929-934 ◽

Cited By ~ 5

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.

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