Abstract
Background: The chemotherapy response score (CRS) system is a reproducible prognostic tool for patients receiving neoadjuvant chemotherapy (NACT) for tubo-ovarian high-grade serous carcinoma (HGSC). Achieving CRS 3 following NACT can be used as a surrogate for progression-free survival (PFS) and overall survival (OS). This study aimed to identify predictors of CRS 3 and develop a predictive nomogram.Methods: Data were extracted from 106 HGSC patients receiving NACT. Logistic regression was used to identify independent predictors for CRS 3. A nomogram was established based on the multivariate regression model.Results: All patients received three cycles of NACT, and CRS 3 was observed in 24 (22.6%) patients. Compared with patients in the CRS 1–2 group, patients in the CRS 3 groups had significantly improved PFS (log-rank test P < 0.0001). The multivariate regression analysis identified post-NACT CA125, percent decrease in CA125, post-NACT human epididymis protein 4 (HE4), and post-NACT hemoglobin level as independent predictors of CRS 3. The Hosmer-Lemeshow test showed goodness-of-fit of this regression model (P = 0.272). The nomogram including these factors presented good discrimination (area under the curve = 0.82), good calibration (mean absolute error = 0.039), and a net benefit within the threshold probabilities of CRS 3 > 5%.Conclusions: We validated the prognostic role of the CRS system and developed a nomogram that predicts the possibility of CRS 3 following NACT. The nomogram helps to identify patients who would benefit the most from NACT. More studies are warranted to validate this model.
Highlights
Ovarian cancer is the most lethal of gynecologic cancer, with a 5-year overall survival (OS) of 45% [1]
Before neoadjuvant chemotherapy (NACT), restricted activity was noted in 13 patients (12.3%); the reasons included massive ascites, pleural effusion and thromboembolic events
One hundred and one patients (95.3%) received carboplatin/paclitaxel every 3 weeks as the NACT regimen, while five (4.7%) patients were treated with weekly carboplatin/paclitaxel because of poor general status
Summary
Ovarian cancer is the most lethal of gynecologic cancer, with a 5-year overall survival (OS) of 45% [1]. For patients with high perioperative risk and patients with a low likelihood of achieving R0 resection in PDS, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) can be considered as an alternative option which has been recommended in the National Comprehensive Cancer Network (NCCN), International Federation of Gynecology and Obstetrics (FIGO) and European Society for Medical Oncology (ESMO) guidelines [2,3,4]. Compared with PDS, NACT-IDS is less morbid and can increase the chances of achieving R0 resection [3]. Even if NACT patients underwent R0 resection in IDS, their survival outcomes were not better than those of patients who had minimal residual disease after PDS [8]. This study aimed to identify predictors of CRS 3 and develop a predictive nomogram
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