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Prognostic Role of Histological Tumor Regression in Patients Receiving Neoadjuvant Chemotherapy for High-Grade Serous Tubo-ovarian Carcinoma
  1. Edwina Coghlan, MBBS, MRANZCOG*,,
  2. Tarek M. Meniawy, MBBS, FRACP, PhD*,,§,
  3. Aime Munro, PhD*,,
  4. Max Bulsara, MSc, PhD,
  5. Colin JR Stewart, FRCPA, MBBS,,#,
  6. Adeline Tan, FRCPA, MBBS,#,
  7. MH Eleanor Koay, FRCPA, MBBS,
  8. Daniel MaGee, BSc**,
  9. Jim Codde, PhD,
  10. Jason Tan, MBBS, FRANZCOG, CGO*,,**,††,
  11. Stuart G. Salfinger, MBBS, FRANZCOG, CGO*,,**,
  12. Ganendra R. Mohan, MBBS, FRANZCOG, CGO*,,
  13. Yee Leung, MBBS, FRANZCOG, CGO,
  14. Cassandra B. Nichols, BSC Post Grad Gen Couns‡‡,§§ and
  15. Paul A. Cohen, FRANZCOG, MD*,,††
  1. * Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco;
  2. Institute for Health Research, University of Notre Dame Australia, Fremantle;
  3. School of Medicine and Pharmacology, University of Western Australia, Crawley;
  4. § Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands;
  5. School of Women’s and Infants’ Health, University of Western Australia, Crawley;
  6. Department of Histopathology, King Edward Memorial Hospital, Subiaco;
  7. # St John of God Pathology, St John of God Subiaco Hospital, Subiaco;
  8. ** School of Medicine, University of Notre Dame Australia, Fremantle;
  9. †† WOMEN Centre, West Leederville;
  10. ‡‡ Genetics Services of Western Australia, King Edward Memorial Hospital, Subiaco, Western Australia; and
  11. §§ Inherited Cancer Connect Partnership, Familial Cancer Centre, Peter MacCallum Cancer Centre, Victoria, Southeast Australia, Australia.
  1. Address correspondence and reprint requests to Paul A. Cohen, FRANZCOG, MD, Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, Western Australia 6008, Australia. E-mail: paul.cohen{at}


Objective Our objective was to validate the prognostic role of the chemotherapy response score (CRS), which has been proposed for measuring tumor response to neoadjuvant chemotherapy in patients with high-grade serous tubo-ovarian carcinoma, in predicting progression-free survival (PFS) and overall survival (OS).

Methods A retrospective cohort study was conducted of patients with advanced high-grade serous tubo-ovarian carcinoma diagnosed between January 1, 2010, and December 31, 2014, and treated with neoadjuvant chemotherapy. Treatment-related tumor regression was determined according to the 3-tier CRS, and results were compared with standard clinicopathological variables. Survival analysis was performed using Cox proportional hazards models and the log-rank test.

Results Seventy-one patients were eligible for analysis. Median OS was 25.5 months. Fifty-eight patients (82%) had disease recurrence and 32 (45%) had died at study census. Of the 71 patients, 19, 29, and 23 patients had a CRS of 1, 2, and 3, respectively. On univariate analysis, the CRS significantly predicted PFS (hazard ratio [HR], 3.77; 95% confidence interval [CI], 1.83–7.78; P = 0.000) and OS (HR, 2.81; 95% CI, 1.16–6.79; P = 0.022). In a multivariate model, the CRS was significantly associated with PFS (HR, 2.81; 95% CI, 1.16–6.79; P = 0.022) but not with OS (HR, 2.39; 95% CI, 0.47–3.08; P = 0.079). Patients with CRS of 1 and 2 combined were twice as likely to progress during the study period compared with patients with a CRS of 3 (HR, 2.0; 95% CI, 1.06–3.78; P = 0.032; median PFS, 16 vs 26 months). No significant association was observed for OS (CRS 1/2 vs 3; HR, 1.57; 95% CI, 0.68–3.65; P = 0.291).

Conclusions In this study, the CRS showed independent prognostic significance for PFS but not for OS.

  • High-grade serous carcinoma
  • Neoadjuvant chemotherapy
  • Chemotherapy response score validation
  • Ovarian cancer
  • Prognosis

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