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The Prognostic Impact of the Pathological Response to Neoadjuvant Dose-Dense Therapy for Ovarian Carcinoma
  1. Takahiro Ebata, MD, PhD*,,
  2. Mayu Yunokawa, MD, PhD,
  3. Hiroshi Yoshida, MD, PhD,
  4. Seiko Bun§,
  5. Tatsunori Shimoi, MD,
  6. Akihiko Shimomura, MD,
  7. Makoto Kodaira, MD, PhD,
  8. Kan Yonemori, MD, PhD,
  9. Chikako Shimizu, MD, PhD,
  10. Yasuhiro Fujiwara, MD, PhD,
  11. Tomoyasu Kato, MD, PhD and
  12. Kenji Tamura, MD, PhD
  1. * Department of Medical Oncology, Chiba University, Chiba; and Departments of
  2. Breast and Medical Oncology,
  3. Pathology,
  4. § Pharmacy, and
  5. Gynecology, National Cancer Center Hospital, Tokyo, Japan.
  1. Address correspondence and reprint requests to Mayu Yunokawa, MD, PhD, Department of Breast and Medical Oncology, National Cancer Center Hospital 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104–0045, Japan. E-mail: myunokaw{at}


Objective The aim of this study was to assess the use of the pathological response to neoadjuvant chemotherapy (NAC) for predicting disease prognosis in patients with advanced ovarian cancer who received neoadjuvant dose-dense weekly paclitaxel and carboplatin (dd-TC) therapy.

Methods We retrospectively investigated patients with advanced epithelial ovarian, tubal, or peritoneal carcinoma treated at our hospital from July 2004 to October 2014. Patients received dd-TC therapy as NAC followed by interval debulking surgery (IDS). Specimens resected during IDS were divided into 4 groups based on pathological response: grade 1, most tumor cells appeared to be viable; grade 2a, most tumor cells had disappeared, whereas the remaining tumor cells were vacuolated or degenerated; grade 2b, small numbers of viable tumor cells were observed; and grade 3, small aggregations of macrophages were seen.

Results Sixty-eight patients were enrolled. The median number of NAC cycles was 3 (range, 2–6), and 51 patients (75.0%) achieved complete resection at IDS. Regarding pathological response, 7 (10.3%) patients were classified as grade 1, 11 (16.2%) as grade 2a, 46 (67.7%) as grade 2b, and 4 (5.9%) as grade 3. In univariate and multivariate analyses, grades 2b and 3 pathological responses were significant favorable prognostic factors for progression-free survival (P = 0.028; hazard ratio, 0.48; 95% confidence interval, 0.26–0.92).

Conclusions Although the pathological complete response rate to NAC was low in this study, both complete and good pathological responses to NAC might be favorable prognostic factors for PFS in patients with advanced ovarian cancer who receive dd-TC.

  • Ovarian cancer
  • Neoadjuvant chemotherapy
  • Dose-dense therapy
  • Pathological response
  • Pathological complete response

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  • The authors declare no conflicts of interest.