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Histopathologic response to neoadjuvant chemotherapy as a prognostic biomarker in tubo-ovarian high-grade serous carcinoma: updated Chemotherapy Response Score (CRS) results
  1. Steffen Böhm1,
  2. Nhu Le2,
  3. Michelle Lockley3,
  4. Elly Brockbank4,
  5. Asma Faruqi5,
  6. Ian Said5,6,
  7. Arjun Jeyarajah4,
  8. Rekha Wuntakal7,
  9. Blake Gilks8 and
  10. Naveena Singh5
  1. 1Department of Medical Oncology, Barts Health NHS Trust, London, UK
  2. 2Cancer Epidemiology and Prevention, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
  3. 3Barts Cancer Institute, Queen Mary University of London, London, UK
  4. 4Department of Gynaecologial Oncology, Barts Health NHS Trust, London, UK
  5. 5Department of Pathology, Barts Health NHS Trust, London, UK
  6. 6Department of Histopathology, Mater Dei Hospital, Msida, Malta
  7. 7Department of Gynaecological Oncology, Queens Hospital, Romford, UK
  8. 8Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Steffen Böhm, Medical Oncology, Barts Health NHS Trust, London EC1A 7BE, UK;{at}


Objective The Chemotherapy Response Scoring (CRS) system was developed to enable reproducible reporting of histologic tumor response in interval debulking specimens following neoadjuvant chemotherapy in advanced stage tubo-ovarian high-grade serous carcinoma. This prognostic biomarker has been included in ovarian cancer pathology reporting guidelines (International Collaboration on Cancer Reporting, College of American Pathologists) and in the upcoming European Society for Medical Oncology-European Society of Gynaecological Oncology (ESMO-ESGO) guidelines for ovarian cancer management. We present follow-up data on the CRS validation initiatives and suggest research with novel therapeutic agents incorporating this biomarker.

Methods The cohort on whom CRS was originally developed was analyzed after an extended follow-up of an additional 36 months. The CRS histopathologic scoring system was applied to omental sections obtained at interval surgery from all 80 patients. Progression-free and overall survival were re-calculated.

Results After a median follow-up of 4.3 years the CRS score predicted progression-free survival with an HR of 0.39 (95% CI 0.21 to 0.70), p = 0.002 adjusted for age, stage, and debulking status (median 1.08 vs 2.27 years for CRS1/2 vs CRS3). CRS was also predictive of overall survival with an HR of 0.17 (95% CI 0.07 to 0.44), p = 0.0002 adjusted for age, stage, and debulking status (median 2.55 vs 5.47 years for CRS1/2 vs CRS3).

Conclusion CRS3 is a reproducible prognostic biomarker for improved progression-free and overall survival in stage 3C or 4 tubo-ovarian high-grade serous carcinoma after neoadjuvant chemotherapy. The score, obtained at interval debulking surgery, can help facilitate research and biomarker driven first-line treatment of patients with advanced ovarian cancer.

  • CRS
  • biomarker
  • chemotherapy response
  • personalised therapy
  • ovarian cancer

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  • BG and NS contributed equally.

  • Funding The Barts Gynae Tissue Bank was supported by Barts and The London Charity.

  • Disclaimer The content of this paper reflects the opinion of the authors.

  • Competing interests None declared.

  • Patient consent Patient consent was obtained.

  • Ethics approval Institutional review board approval was granted for collection of tissue and clinical information.

  • Provenance and peer review Not commissioned; externally peer reviewed.