IMR Press / CEOG / Volume 49 / Issue 7 / DOI: 10.31083/j.ceog4907147
Open Access Original Research
Real World Application of Chemotherapy Response Score in High Grade Serous Cancer of the Ovary
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1 Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
2 Department of Obstetrics and Gynecology, AOUI-University of Verona, 37129 Verona, Italy
3 Department of Phatology, Spedali Civili di Brescia, 25123 Brescia, Italy
*Correspondence: (Francesca Cisotto)
These authors contributed equally.
Academic Editor: Shigeki Matsubara
Clin. Exp. Obstet. Gynecol. 2022, 49(7), 147;
Submitted: 7 May 2022 | Revised: 7 June 2022 | Accepted: 10 June 2022 | Published: 30 June 2022
(This article belongs to the Special Issue Current Research on Endometrial and Ovarian Cancers)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: High grade serous cancers (HGSC) of gynecological origin can be treated with neoadjuvant chemotherapy (NACT) and subsequent interval debulking surgery (IDS) when upfront surgery is not feasible. Chemotherapy response score (CRS) was proposed to evaluate on pathological specimens at IDS the response to NACT. Objective: We aim to assess survival outcomes stratified by CRS in HGSC patients and to explore interaction with residual disease (RD) after surgery. Methods: We identified all consecutive patients with HGSC at advanced stage (FIGO III–IV) that underwent NACT and IDS. We collected baseline data as well as survival data such as disease-free survival (DFS) and overall survival (OS). CRS was assessed on adnexal and omental specimens based on a three-tier classification. We conducted multivariate cox regression analyses of CRS classifications (CRS 1 vs 2 vs 3, CRS 1+2 vs 3 and CRS 1 vs 2+3) using RD as covariate. Results: We enrolled 47 patients with a median follow-up of 25 months (IQR: 11–78). RD after IDS failed to correlate with DFS (p = 0.73) and OS (p = 0.93). Adnexal CRS 2 (HR 0.4; 95% CI 0.2–1.0; p = 0.05) and CRS 3 (HR 0.30; 95% CI 0.11–0.65; p = 0.04) correlated with longer DFS. Moreover, CRS 2 (HR 0.12; 95% CI 0.04–0.33; p < 0.01) and CRS 3 (HR 0.06; 95% CI 0.02–0.20; p < 0.01) on adnexal specimens were significantly associated with improved OS. Neither the omental three-tier nor the two-tier classifications correlated with DFS and OS. Conclusions: CRS classification is apparently a simple and reproducible method. In our study the adnexal three-tier system correlate with DFS and OS independently from RD at IDS. Further studies are needed to clarify the clinical role of CRS classification.

ovarian cancer
chemotherapy response score
debulking surgery
Fig. 1.
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