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Survival impact of histological response to neoadjuvant chemotherapy according to number of cycles in patients with advanced ovarian cancer
  1. Sarah Betrian1,
  2. Martina Aida Angeles2,
  3. Antonio Gil Moreno3,4,
  4. Bastien Cabarrou5,
  5. Marion Deslandres1,
  6. Gwenael Ferron2,
  7. Eliane Mery6,
  8. Anne Floquet7,
  9. Frederic Guyon8,
  10. Assumpció Pérez-Benavente3,
  11. Emanuela Spagnolo9,
  12. Agnieszka Rychlik10,
  13. Laurence Gladieff1,
  14. Alicia Hernández Gutiérrez9 and
  15. Alejandra Martinez2
  1. 1Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
  2. 2Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
  3. 3Gynecology, Vall d'Hebron Hospital, Barcelona, Spain
  4. 4Universitat Autònoma de Barcelona, Barcelona, Spain
  5. 5Biostatistics Unit, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
  6. 6Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
  7. 7Medical Oncology Department, Institut Bergonié, Bordeaux, France
  8. 8Surgical oncology, Institut Bergonié, Bordeaux, France
  9. 9Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
  10. 10Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warszawa, Poland
  1. Correspondence to Dr Sarah Betrian, Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse 31100, France; betrian.sarah{at}


Objective We sought to evaluate the impact of chemotherapy response score according to the number of cycles of neoadjuvant chemotherapy, on disease-free survival and overall survival, in patients with advanced epithelial ovarian cancer ineligible for primary debulking surgery.

Methods This multicenter retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent 3–4 or 6 cycles of a platinum and taxane-based neoadjuvant chemotherapy, followed by complete cytoreduction surgery (CC-0) or cytoreduction to minimal residual disease (CC-1), between January 2008 and December 2015, in four institutions. Disease-free survival and overall survival were assessed according to the histological response to chemotherapy defined by the validated chemotherapy response score.

Results A total of 365 patients were included: 219 (60.0%) received 3–4 cycles of neoadjuvant chemotherapy, and 146 (40.0%) had 6 cycles of neoadjuvant chemotherapy before cytoreductive surgery. There were no significant differences in early relapses, disease-free survival, and overall survival according to the number of neoadjuvant chemotherapy cycles. However, regardless of the number cycles of neoadjuvant chemotherapy, persistent extensive histological disease (chemotherapy response score 1–2) was significantly associated with a higher peritoneal cancer index, minimal residual disease (CC-1), and early relapses. Median disease-free survival in patients with complete or near-complete response (score 3) was 28.3 months (95% CI 21.6 to 36.8), whereas it was 16.3 months in patients with chemotherapy response score 1–2 (95% CI 14.7 to 18.0, p<0.001).

Conclusion In our cohort, the number of neoadjuvant chemotherapy cycles was not associated with disease-free survival or overall survival. Chemotherapy response score 3 improved oncological outcome regardless of the number of neoadjuvant chemotherapy cycles.

  • Ovarian Cancer
  • Pathology
  • Surgical Oncology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors SB, MAA and AM contributed to the study conception and design, drafting the manuscript and analysis and interpretation of the data. SB, MAA, AM and BC contributed to the acquisition of the data, interpretation of the analysis results and clinical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. SB is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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