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Prognostic Value of Pathologic Chemotherapy Response Score in Patients With Ovarian Cancer After Neoadjuvant Chemotherapy
  1. Nadav Michaan, MD*,,
  2. Woo Yoo Chong, MD,
  3. Na Young Han, MD,
  4. Myong Cheol Lim, MD, PhD,§, and
  5. Sang Yoon Park, MD, PhD,§,
  1. *Lis Maternity Hospital, Tel Aviv Sourasky Medical center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
  2. Common Cancer Branch and Center for Uterine Cancer, Goyang, Republic of Korea.
  3. Department of Pathology, National Cancer Center, Goyang, Republic of Korea.
  4. §Cancer Healthcare Research Branch, Research Institute, Goyang, Republic of Korea.
  5. Center for Uterine Cancer and Center for Clinical Trials, Research Institute Hospital, Goyang, Republic of Korea.
  6. Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
  1. Address correspondence and reprint requests to Nadav Michaan, MD, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weismann St, Tel Aviv, Israel, 6296317. E-mail: nadavmi{at}


Objectives The aim of the study was to investigate the correlation of chemotherapy response score (CRS) after neoadjuvant chemotherapy (NACT) to treatment outcomes in ovarian cancer (OC).

Methods Chemotherapy response score was retrospectively determined on pathology slides of all patients with epithelial OC that had interval debulking surgery (IDS) between 2009–2014. Chemotherapy response score 1 was given when tumor was present and infiltrated by inflammatory cells, CRS 2 when both tumor and regressive chemotherapy changes were present, and CRS 3 when scant tumor was seen within extensive chemotherapy-induced changes. Patients’ characteristics including survival data were collected and compared between CRS groups.

Results Pathology slides of 132 patients were reviewed. Forty-nine patients had CRS 1, 65 had CRS 2, and 18 had CRS 3. Age, stage, and grade were not different across CRS groups. A higher percent of CRS 1 and 2 patients required more than 3 cycles of NACT, whereas CRS 3 patients had higher rates of no residual disease at completion of IDS. Chemotherapy response score 3 group showed the most significant CA125 decrease after NACT (97% decrease, P = 0.016). Kaplan-Meir survival curves showed a significantly longer progression-free survival but not overall survival for patients with CRS 3 (median progression-free survival = 7.5, 12, and 17 months for CRS 1, 2, and 3, respectively, P = 0.012), and this remained statistically significant in both univariate and multivariate analysis. Interobserver reproducibility for CRS was good (weighed κ = 0.762).

Conclusions Patients with CRS 3 have longest progression-free survival and highest CA125 drop after NACT. These parameters have important prognostic value and can be used for clinical decision-making.

  • Ovarian cancer
  • Chemotherapy response score
  • Neoadjuvant chemotherapy
  • Prognosis

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  • Chemotherapy response score is a pathological scoring system that evaluates response to chemotherapy.

    Patients with chemotherapy response score 3 have the longest progression-free survival after neoadjuvant chemotherapy.

    Chemotherapy response score can be used as a prognostic factor in patients with ovarian cancer.

  • The authors declare no conflicts of interest.