Huo Chuying, Wu Bin, Ye Dongdong, Xu Miaochun, Ma Shaolin, Cheng Aoshuang, Liu Yunyun, Huang Chunxian, Zhang Yuhao, Lin Zhongqiu, Li Bowen, Lu Huaiwu
Department of Gynecologic Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, China.
Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, 510120, China.
BMC Cancer. 2024 Dec 18;24(1):1536. doi: 10.1186/s12885-024-13324-0.
A validated prognostic index for the outcome of patients with advanced high-grade serous ovarian cancer (HGSOC) undergoing neoadjuvant chemotherapy (NACT) remains elusive. To address this need, we developed an ovarian neoadjuvant chemotherapy prognostic index (ONCPI) to improve predictive accuracy.
We encompassed an analysis of the clinicopathological characteristics of patients with advanced HGSOC who were administered platinum-based NACT. Blood inflammatory composite markers were calculated and converted into binary values using optimal cutoffs. Omental hematoxylin and eosin (H&E) stained slides were selected for the assessment of chemotherapy response score (CRS), which served as a measure of NACT efficacy. Logistic regression analysis and Cox proportional hazards regression model were utilized to construct a prognostic index.
Multivariate logistic analysis showed that both CRS and neutrophil-to-lymphocyte ratio (NLR) independently influenced the response to platinum-based chemotherapy. Meanwhile, Kaplan-Meier and Cox regression analysis revealed that CRS score was significantly correlated with progression-free survival (PFS) and overall survival (OS), and patients with high NLR showed poor OS. We further developed an ovarian neoadjuvant chemotherapy prognostic index (ONCPI) based on the CRS and NLR. The area under the curve (AUC) value of ONCPI was 0.771 (P < 0.001, 95% CI: 0.656-0.887) for the prediction of platinum resistance. This AUC value surpasses that of the individual NLR and CRS, which were 0.670 (P = 0.018, 95% CI: 0.547-0.793) and 0.714 (P = 0.003, 95% CI: 0.590-0.839), respectively. Moreover, survival analysis suggested that patients with ONCPI of 0 and 1 were significantly associated with improved PFS and OS.
The ONCPI emerges as a significant prognostic marker for predicting NACT outcome in advanced HGSOC patients and holds promise for integration into clinical practice and risk-stratified trial design.
对于接受新辅助化疗（NACT）的晚期高级别浆液性卵巢癌（HGSOC）患者，尚未有经过验证的预后指标。为满足这一需求，我们开发了一种卵巢新辅助化疗预后指数（ONCPI）以提高预测准确性。
我们纳入了对接受铂类NACT的晚期HGSOC患者的临床病理特征分析。计算血液炎症复合标志物，并使用最佳临界值将其转换为二元值。选择网膜苏木精和伊红（H&E）染色切片来评估化疗反应评分（CRS），该评分作为NACT疗效的一项指标。采用逻辑回归分析和Cox比例风险回归模型构建预后指数。
多因素逻辑分析表明，CRS和中性粒细胞与淋巴细胞比值（NLR）均独立影响对铂类化疗的反应。同时，Kaplan-Meier分析和Cox回归分析显示，CRS评分与无进展生存期（PFS）和总生存期（OS）显著相关，NLR高的患者OS较差。我们进一步基于CRS和NLR开发了卵巢新辅助化疗预后指数（ONCPI）。ONCPI预测铂耐药的曲线下面积（AUC）值为0.771（P < 0.001，95%CI：0.656 - 0.887）。该AUC值超过了单独的NLR和CRS的AUC值，分别为0.670（P = 0.018，95%CI：0.547 - 0.793）和0.714（P = 0.003，95%CI：0.590 - 0.839）。此外，生存分析表明，ONCPI为0和1的患者与改善的PFS和OS显著相关。
ONCPI成为预测晚期HGSOC患者NACT结局的重要预后标志物，有望整合到临床实践和风险分层试验设计中。
