Le T, Williams K, Senterman M, Hopkins L, Faught W, Fung-Kee-Fung M
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, Ottawa General Hospital, Ottawa, Ontario, Canada.
Gynecol Oncol. 2007 Jul;106(1):160-3. doi: 10.1016/j.ygyno.2007.03.029. Epub 2007 May 9.
To assess the prognostic significance of pathologic tumour response to neoadjuvant chemotherapy.
Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer cases treated with neoadjuvant chemotherapy. Pathologic assessments of the extent of: tumour necrosis, fibrosis, macrophage infiltration, and tumour induced inflammation were graded on an ordinal scale of 0 to 2 (none/minimal, moderate, extensive). All pathology slides were reviewed and graded by one gynecologic pathologist. A composite pathologic tumour response score was calculated by summing all above pathologic assessments for each sample. Cox proportional hazard models were built to model time to clinical progression and death using predictor variables of: age, tumour grade, residual disease, and pathologic tumour response score. All p values less than 0.05 were considered to be statistically significant.
Sixty-two cases with available slides for reviews were identified retrospectively. Optimal debulking was achieved in 46 cases (74%). Significant predictors for prolonged progression free survival included: younger age (p=0.05), optimal tumour residual status (p=0.016), and higher composite pathologic tumour response score (HR 0.848, 95% CI 0.742-0.970, p=0.0016). Cox regression modeling revealed only one significant predictive variable of time to disease related death being the composite pathologic tumour response score (HR 0.695, 95% CI=0.515-0.938, p=0.017).
Pathologic assessments of tumour response to chemotherapy are helpful in determining prognosis and could be used to guide subsequent therapeutic decisions. The proposed composite pathologic tumour response score warrants further studies and validation.
评估新辅助化疗后病理肿瘤反应的预后意义。
对1997年至2005年的病历进行回顾性分析，以确定接受新辅助化疗的卵巢癌病例。对肿瘤坏死、纤维化、巨噬细胞浸润和肿瘤诱导炎症的程度进行病理评估，按0至2级顺序分级（无/最小、中度、广泛）。所有病理切片均由一名妇科病理学家进行复查和分级。通过对每个样本的上述所有病理评估求和，计算出综合病理肿瘤反应评分。构建Cox比例风险模型，以年龄、肿瘤分级、残留疾病和病理肿瘤反应评分为预测变量，模拟临床进展和死亡时间。所有p值小于0.05被认为具有统计学意义。
回顾性确定了62例有可用切片供复查的病例。46例（74%）实现了最佳肿瘤细胞减灭术。无进展生存期延长的显著预测因素包括：年龄较小（p=0.05）、最佳肿瘤残留状态（p=0.016）和较高的综合病理肿瘤反应评分（HR 0.848，95%CI 0.742-0.970，p=0.0016）。Cox回归模型显示，与疾病相关死亡时间的唯一显著预测变量是综合病理肿瘤反应评分（HR 0.695，95%CI=0.515-0.938，p=0.017）。
化疗后肿瘤反应的病理评估有助于确定预后，并可用于指导后续治疗决策。所提出的综合病理肿瘤反应评分值得进一步研究和验证。
