Prognostic implications of histological tumor regression (Böhm's score) in patients receiving neoadjuvant chemotherapy for high grade serous tubal &amp; ovarian carcinoma

Rajkumar, Savithri; Polson, Alexander; Nath, Rahul; Lane, Geoffrey; Sayasneh, Ahmad; Jakes, Adam D; Begum, Shahina; Mehra, Gautam

doi:10.1016/j.ygyno.2018.08.042

Cited by 31 publications

(35 citation statements)

References 14 publications

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“…Recently, the International Collaboration on Cancer reporting (ICCR) issued guidelines on the reporting of pelvic HGSC and recommended the inclusion of a 3‐point scoring system, namely the Chemotherapy Response Score (CRS) that was developed by Böhm et al, as standard for assessment of tumor regression following NACT . For improving inter‐observer reproducibility of CRS, the training web site has been launched; furthermore, various external validation studies have confirmed the prognostic impact of CRS . However, assessment of CRS requires an appropriate number of sampling from the omentum and training of the scoring practice .…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of intraoperative peritoneal cytology in interval debulking surgery for pelvic high‐grade serous carcinoma

et al. 2019

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Background and Objectives The aim of this study was to determine whether peritoneal washing cytology (PWC) during interval debulking surgery (IDS) could predict the prognosis of patients with pelvic high‐grade serous carcinoma (HGSC) achieving R0 status. Methods Between January 2007 and May 2018, 110 patients with ovarian/tubal/primary peritoneal HGSC received platinum‐based neo‐adjuvant chemotherapy, followed by IDS at National Cancer Center Hospital, Japan. All the patients achieved R0 debulking status, defined as no macroscopic residual tumor in the peritoneal cavity at the completion of IDS. PWC was performed before debulking during IDS. The survival outcomes were compared between the PWC‐positive and PWC‐negative groups. Results The median progression free survival (PFS) for the entire cohort was 17 months (range, 5‐133 months). The median PFS for the PWC‐positive group was significantly shorter than that of the PWC‐negative group (16 vs 19 months, HR 2.04, 95% CI 1.22‐3.41, P ‐value < 0.01). Increased risk of progression was observed on both univariate and multivariate analyses, including age and FIGO stage (HR 2.28; 95% CI 1.35‐3.84, P < 0.01). Conclusions The positive PWC during IDS was found to predict earlier disease recurrence in patients with pelvic HGSC achieving R0 status. As performing PWC during IDS becomes standard practice, prospective validation should be conducted in the future.

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Section: Discussionmentioning

confidence: 99%

Prognostic impact of intraoperative peritoneal cytology in interval debulking surgery for pelvic high‐grade serous carcinoma

et al. 2019

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“…The CRS score has been independently validated in several countries . Reproducibility of CRS assignment between pathologists from different centres and with different levels of experience has been noted .…”

Section: Crs In High Grade Serous Tubo‐ovarian Carcinoma (Hgsc)mentioning

confidence: 99%

“…13 The CRS score has been independently validated in several countries. [14][15][16] Reproducibility of CRS assignment between pathologists from different centres and with different levels of experience has been noted. 17 In their study, Ditzel and colleagues noted that the interobserver agreement of the three-tiered CRS scoring system was moderate, with a K-value of 0.48 at the first instance.…”

Section: R E P R O D U C I B I L I T Y a N D V A L I D A T I O Nmentioning

confidence: 99%

Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers

Williams

Ganesan

2019

Histopathology

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Standardisation of pathological evaluation of tissue responses to therapy permits robust stratification of patient outcomes for management decisions and allows comparison of results across clinical trials. In gynaecological pathology there are two major areas where pathological assessment of treatment response is currently used to determine ongoing therapy. High‐grade serous carcinoma (HGSC) of tubo‐ovarian origin frequently presents as high‐stage disease and may be managed by neoadjuvant chemotherapy with debulking surgery. The chemotherapy response score (CRS) is a reproducible, validated three‐tiered morphological scoring system to assess the response of HGSC to treatment. Interobserver agreement is shown to be substantial following online training, and women with CRS3 have significantly improved progression‐free and overall survival. Low‐grade endometrioid endometrial cancer and atypical hyperplasia/endometrioid intraepithelial neoplasia may be managed by progestogenic therapy in women who wish to preserve fertility or for whom medical co‐morbidities preclude surgical management. The response to treatment is assessed histologically in successive endometrial biopsies. The histological parameters are well described, but the pathological classification of treatment response is still under development. Pathological assessment of the response to treatment is incorporated into clinical guidelines.

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“…In the 2019 European Society for Medical Oncology (ESMO) ovarian cancer guidelines, a three-tiered chemotherapy response score (CRS) system was recommended for patients receiving NACT to evaluate tumor response and predict prognosis [15]. Since its description, the CRS system has been independently assessed in many studies [16][17][18][19][20][21]. Currently, it is considered an accurate and highly reproducible method to predict survival outcomes for patients with tubo-ovarian high-grade serous carcinoma (HGSC) [15].…”

Section: Introductionmentioning

confidence: 99%

The Added Value of CA125 Normalization Before Interval Debulking Surgery to the Chemotherapy Response Score for the Prognostication of Ovarian Cancer Patients Receiving Neoadjuvant Chemotherapy for Advanced Disease

Liang

Lijuan

et al. 2020

Preprint

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Objective: To investigate whether CA125 normalization following neoadjuvant chemotherapy (NACT) can complement the chemotherapy response system (CRS) in the prognostication of patients with tubo-ovarian high-grade serous carcinoma (HGSC).Methods: In total, 106 HGSC patients who received NACT followed by interval debulking surgery (IDS) for FIGO stage IIIC-IV disease were included, and their clinical data were retrospectively reviewed. The primary endpoint was progression-free survival (PFS). Cox regression analysis was performed to identify predictors of PFS.Results: Following NACT, CRS3 was noted in 24 patients (22.6%), and CA125 normalization (≤ 35 U/ml) was noted in 54 patients (50.9%). Both CRS3 and CA125 normalization were identified as independent prognosticators of PFS. Combining these two factors, we stratified the 106 patients into three groups with different risks of recurrence: low-risk group (CRS3 + post-NACT CA125≤ 35 U/ml; n = 17, 16.0%), intermediate-risk group (CRS3 + post-NACT CA125 > 35 U/ml; n = 7, 6.6%) and high-risk group (CRS1-2; n= 82, 77.4%). The differences in PFS between the three groups were significant (log-rank test, P < 0.0001). In Cox regression analyses, the new stratification method was found to have an independent prognostic effect.Conclusion: Both the CRS system and the normalization of CA125 following NACT could reliably predict the risk of recurrence following primary treatment. The combination of the two factors refined the prognostic stratification of HGSC patients who were treated with NACT and IDS.

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Prognostic implications of histological tumor regression (Böhm's score) in patients receiving neoadjuvant chemotherapy for high grade serous tubal & ovarian carcinoma

Cited by 31 publications

References 14 publications

Prognostic impact of intraoperative peritoneal cytology in interval debulking surgery for pelvic high‐grade serous carcinoma

Prognostic impact of intraoperative peritoneal cytology in interval debulking surgery for pelvic high‐grade serous carcinoma

Role of the pathologist in assessing response to treatment of ovarian and endometrial cancers

The Added Value of CA125 Normalization Before Interval Debulking Surgery to the Chemotherapy Response Score for the Prognostication of Ovarian Cancer Patients Receiving Neoadjuvant Chemotherapy for Advanced Disease

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