Abstract
Introduction and aims of the study: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) for the management of advanced epithelial ovarian cancer (EOC) represents an alternative approach to primary debulking with comparable survival outcomes. Histopathologic examination of the IDS specimens and the evaluation of Chemotherapy Response Score (CRS) have been proposed as significant markers of response to NACT. The objective of our study was to evaluate the prognostic significance of CRS in OC patients treated with NACT. Methods: Medical records of patients with OC stage ≥ III who were selected to receive NACT in our institution from 2011 to 2018 were retrospectively evaluated. CRS was assessed on both omental and ovarian samples according to International Collaboration on Cancer Reporting (ICCR) recommendation. Lymphocytic infiltration, presence of necrosis and mitotic index were also assessed. Results: A total of 60 patients with median age of 65 years at diagnosis were included. A total of 20 and 10 patients received score 3 in CRS at omentum and ovarian samples, respectively. Patients with CRS3 at omentum had significantly prolonged median Progression Free Survival (PFS) compared to CRS1 and CRS2 (19 vs 10 vs 15 months, respectively, p = 0.002), while no difference was observed in the respective OS among the groups (42 vs 28 vs 32.3 months, respectively). Lymphocytic infiltration in pre-treatment biopsies was related to improved PFS and OS (log-rank p = 0.01 and p = 0.015, respectively). No effect on either PFS or OS was observed in patients who received bevacizumab post-IDS, while in patients with lymphocytic infiltration bevacizumab negatively affected PFS. Conclusions: Our study highlights the role of CRS in the prediction of the postoperative course of EOC patients who undergo NACT and IDS. Further studies are needed to decipher the exact role of CRS and lymphocytic infiltration so as to personalize the treatment of EOC patients.
Published Version
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