Department of Pathology, National Cancer Center.
Int J Gynecol Cancer. 2018 Nov;28(9):1676-1682. doi: 10.1097/IGC.0000000000001366.
The 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).
Chemotherapy 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.
Pathology 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).
Patients 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.
本研究旨在探讨新辅助化疗（NACT）后化疗反应评分（CRS）与卵巢癌（OC）治疗结局的相关性。
回顾性分析 2009-2014 年间行间隔中间性肿瘤细胞减灭术（IDS）的上皮性 OC 患者的病理切片，确定化疗反应评分。肿瘤存在并被炎症细胞浸润时，给予 CRS1；肿瘤和退行性化疗变化均存在时，给予 CRS2；广泛化疗诱导的变化中仅可见少量肿瘤时，给予 CRS3。收集患者特征及生存数据，并比较 CRS 组间差异。
共回顾 132 例患者的病理切片。49 例患者 CRS1，65 例 CRS2，18 例 CRS3。CRS 组间年龄、分期和分级无差异。CRS1 和 2 组需要接受 NACT 超过 3 个周期的患者比例较高，而 CRS3 组 IDS 完成时无残留疾病的比例较高。CRS3 组 NACT 后 CA125 下降最显著（下降 97%，P = 0.016）。Kaplan-Meier 生存曲线显示，CRS3 患者的无进展生存期显著延长（中位无进展生存期分别为 CRS1、2、3 组的 7.5、12 和 17 个月，P = 0.012），且在单因素和多因素分析中均具有统计学意义。CRS 的观察者间可重复性较好（加权κ=0.762）。
CRS3 患者的无进展生存期最长，NACT 后 CA125 下降最明显。这些参数具有重要的预后价值，可用于临床决策。
