Department of Obstetrics and Gynecology, Ospedale degli Infermi, Ponderano (BI), Biella, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, Pathology Division, Department of Woman, Child and Public Health, Rome, Italy.
Int J Gynecol Cancer. 2020 Jan;30(1):67-73. doi: 10.1136/ijgc-2019-000561. Epub 2019 Nov 21.
The chemotherapy response score (CRS) has been developed for measuring response to neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma. This study aimed to validate the ability of this three-tier scoring system of pathologic response on omental specimens to determine prognosis in a subgroups of patients who had clinical complete response to neoadjuvant chemotherapy.
This was a retrospective study, conducted in women receiving interval debulking surgery at the Division of Gynecologic Oncology, between December 2007 and April 2017. Inclusion criteria were: high-grade serous ovarian cancer, FIGO stage IIIC/IV, platinum-based neoadjuvant chemotherapy, and clinical complete response after neoadjuvant chemotherapy (normalization in CA125 levels, disappearance of all target and non-target lesions according to RECIST 1.1). CRS was defined by a single pathology review and classified as previously reported: CRS1, no or minimal tumor response with fibroinflammatory changes limited to a few foci ranging from multifocal or diffuse regression-associated fibroinflammatory changes with viable tumor in sheets, or nodules to extensive regression-associated fibroinflammatory changes with multifocal residual tumor; CRS2, appreciable tumor response with viable tumor readily identifiable; and CRS3, complete absence of tumor or nodules with maximum size of 2 mm. CRS was analyzed according to clinical variables and survival.
A total of 108 patients were eligible for analysis. The average age was 65 (range 36-85) years. A total of 91 (84.3%) patients had stage IIIC disease and 17 (15.7%) patients had stage IV disease. No statistically significant differences were observed in terms of age, FIGO stage, CA125 serum levels, type of chemotherapy schedules, and number of cycles between the three groups. Patients in the CRS3 group had a longer median progression-free survival (25.8 months) compared with CRS2 or CRS 1 (20.3 vs 17.4 months, respectively; p=0.001). Median overall survival was 68.9 months for CRS3, 35.0 months for CRS2, and 45.9 months for CRS1 (p=0.034).
Complete or near-complete pathologic response assessed in the omental specimens of advanced epithelial ovarian carcinoma patients after neoadjuvant chemotherapy (CRS3) is predictive of prolonged progression-free and overall survival. In particular, this is true in women with a clinical complete response.
化疗反应评分（CRS）已被开发用于衡量新辅助化疗治疗卵巢输卵管高级别浆液性癌的反应。本研究旨在验证这种三层次病理反应评分系统在新辅助化疗临床完全缓解的亚组患者中对确定预后的能力。
这是一项回顾性研究，在 2007 年 12 月至 2017 年 4 月期间，在妇科肿瘤学系接受间隔减瘤手术的女性中进行。纳入标准为：高级别浆液性卵巢癌，FIGO 分期 III C/IV 期，基于铂类的新辅助化疗，新辅助化疗后临床完全缓解（CA125 水平正常化，根据 RECIST 1.1 标准所有靶病灶和非靶病灶消失）。CRS 由单一病理回顾定义，并按先前报道进行分类：CRS1，无肿瘤或极小的反应，仅局限于少数灶的纤维炎性改变，范围从弥漫性或多灶性与存活肿瘤相关的纤维炎性改变，到广泛与存活肿瘤相关的纤维炎性改变，伴有结节；CRS2，明显的肿瘤反应，易于识别存活肿瘤；CRS3，肿瘤或结节完全不存在，最大直径为 2mm。根据临床变量和生存情况分析 CRS。
共 108 例患者符合分析条件。平均年龄为 65 岁（范围 36-85 岁）。91 例（84.3%）患者为 III C 期疾病，17 例（15.7%）患者为 IV 期疾病。三组间在年龄、FIGO 分期、CA125 血清水平、化疗方案类型和周期数方面无统计学差异。CRS3 组患者的无进展生存期（25.8 个月）明显长于 CRS2 或 CRS1 组（分别为 20.3 和 17.4 个月；p=0.001）。CRS3 组的总生存期为 68.9 个月，CRS2 组为 35.0 个月，CRS1 组为 45.9 个月（p=0.034）。
在新辅助化疗后上皮性卵巢癌患者的大网膜标本中评估的完全或近乎完全的病理反应（CRS3）可预测无进展生存期和总生存期的延长。特别是在临床完全缓解的女性中，这一点是真实的。
