Department of Clinical Therapeutics, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Department of Pathology, Alexandra General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
Gynecol Oncol. 2020 Jun;157(3):599-605. doi: 10.1016/j.ygyno.2020.03.008. Epub 2020 Mar 12.
Neoadjuvant Chemotherapy (NACT) followed by Interval Debulking Surgery (IDS) is an accepted frontline treatment in patients with advanced Epithelial Ovarian Cancer (EOC). Histopathologic assessment of tumor post NACT may provide a surrogate for response to treatment. The present study aims to characterize the pathological response and to examine its prognostic significance in these patients. Medical records of women with EOC treated in our institution from 2011 to 2016 were retrospectively identified. IDS specimens were reviewed by study pathologist and Chemotherapy Response Score (CRS), lymphocytic infiltration, necrosis and mitosis were assessed. 55 patients with EOC treated with NACT were identified and 48 had complete clinical and pathological data. Median age was 63 years. CRS assessed at omentum predicted PFS when adjusted for age, stage, debulking status (complete, optimal, suboptimal) and post IDS bevacizumab administration (mPFS CRS 1 vs 2 vs 3: 10.3-14-18.7 months 95% CI [7.4-15.7], [12.2-22.9], [13.5-31.3]). Presence of lymphocytic infiltration was associated with improved OS (log-rank test P = 0.015). Post IDS bevacizumab was associated with shorter PFS in patients with lymphocytic infiltration. BRCA status was known for 25 patients and presence of BRCA1/2 mutations was strongly correlated with lymphocytic infiltration (P = 0.011) but not CRS omentum (P = 0.926). Our study confirms the predictive value of CRS in EOC patients treated with NACT and IDS, but also demonstrates the prognostic significance of lymphocytic infiltration as well as its possible interaction with bevacizumab treatment.
新辅助化疗（NACT）后间隔减瘤术（IDS）是晚期上皮性卵巢癌（EOC）患者的一种公认的一线治疗方法。NACT 后肿瘤的组织病理学评估可能是治疗反应的替代指标。本研究旨在描述这些患者的病理反应，并探讨其预后意义。回顾性确定了 2011 年至 2016 年在我院接受治疗的 EOC 女性的病历。研究病理学家对 IDS 标本进行了复查，并评估了化疗反应评分（CRS）、淋巴细胞浸润、坏死和有丝分裂。确定了 55 例接受 NACT 治疗的 EOC 患者，其中 48 例有完整的临床和病理数据。中位年龄为 63 岁。调整年龄、分期、减瘤状态（完全、最佳、次优）和 IDS 后贝伐单抗给药后，网膜上的 CRS 预测了无进展生存期（mPFS CRS 1 比 2 比 3：10.3-14-18.7 个月 95%CI[7.4-15.7]，[12.2-22.9]，[13.5-31.3]）。淋巴细胞浸润的存在与 OS 改善相关（对数秩检验 P=0.015）。在存在淋巴细胞浸润的患者中，IDS 后贝伐单抗与较短的 PFS 相关。已知 25 例患者的 BRCA 状态，BRCA1/2 突变的存在与淋巴细胞浸润呈强相关（P=0.011），但与网膜 CRS 无关（P=0.926）。本研究证实了 CRS 在接受 NACT 和 IDS 治疗的 EOC 患者中的预测价值，同时还证明了淋巴细胞浸润的预后意义及其与贝伐单抗治疗的可能相互作用。
