J Gynecol Oncol.  2017 Nov;28(6):e73. 10.3802/jgo.2017.28.e73.

External validation of chemotherapy response score system for histopathological assessment of tumor regression after neoadjuvant chemotherapy in tubo-ovarian high-grade serous carcinoma

• Lee JY
• Chung YS
• Na K
• Kim HM
• Park CK
• Nam EJ
• Kim S
• Kim SW
• Kim YT
• Kim HS

• KMID: 2413200
• DOI: http://doi.org/10.3802/jgo.2017.28.e73

Abstract

OBJECTIVE
The chemotherapy response score (CRS) system based on histopathological examination has been recently proposed for tubo-ovarian high-grade serous carcinoma (HGSC) to assess response to neoadjuvant chemotherapy (NAC). This study was aimed at validating the CRS system in an external cohort of tubo-ovarian HGSC patients.
METHODS
This study included 110 tubo-ovarian HGSC patients who underwent NAC followed by interval debulking surgery. The 3-tiered CRS of the omental and adnexal tissue sections was determined by 3 independent pathologists. Differences in patient outcomes according to CRS were analyzed.
RESULTS
The CRS system was highly reproducible among the 3 pathologists. Fleiss' kappa value and Kendall's coefficient of concordance for the omental CRS were 0.656 and 0.669, respectively. The omental CRS significantly predicted progression-free survival (PFS). The median PFS of patients whose tumors exhibited the omental CRS 1-2 (15 months) was significantly shorter than that of patients with an omental CRS of 3 (19 months; p=0.016). In addition, after adjusting for age, stage, and debulking status, the omental CRS was an independent prognostic factor for PFS of tubo-ovarian HGSC patients who were treated with NAC (adjusted hazard ratio [HR]=1.74; 95% confidence interval [CI]=1.05-2.87).
CONCLUSION
The CRS system for assessing NAC response was a reproducible prognostic tool in our cohort. The application of the CRS system after NAC can improve survival estimation in HGSC patients.

Keyword

Ovarian Neoplasms; Tubo-ovarian High-grade Serous Carcinoma; Chemotherapy Response Score; Neoadjuvant Chemotherapy; Interval Debulking Surgery; Progression-free Survival

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma/*drug therapy/pathology
Cytoreduction Surgical Procedures
Disease-Free Survival
Fallopian Tube Neoplasms/*drug therapy/pathology
Female
Humans
Middle Aged
*Neoadjuvant Therapy
Neoplasm Grading
Neoplasm Staging
Neoplasms, Cystic, Mucinous, and Serous/*drug therapy/pathology
Omentum/surgery
Ovarian Neoplasms/*drug therapy/pathology
Ovariectomy
Proportional Hazards Models
Reproducibility of Results
Retrospective Studies
Salpingectomy
Treatment Outcome