Six cycles of neoadjuvant chemotherapy followed by cytoreduction in high-grade serous ovarian cancer: prognostic implications of the chemotherapy response score, CA-125, and tumor-infiltrating lymphocytes.

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Andre Lopes, Marilia Albanezi Bertolazzi, Samantha Cabral Severino da Costa, Valesca Bizinoto, Rossana Veronica Mendoza Lopez, Maria Luiza Nogueira Dias Genta, Jesus Paula Carvalho, Filomena Marino Carvalho
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引用次数: 0

Abstract

Objective: To evaluate the prognostic value of the chemotherapy response score, a histopathologic grading system for tumor regression following neoadjuvant chemotherapy, along with post-treatment serum CA-125 levels and tumor-infiltrating lymphocyte density, in patients with high-grade serous ovarian carcinoma treated with 6 cycles of neoadjuvant chemotherapy followed by surgery.

Methods: This retrospective cohort study included patients with histologically confirmed high-grade serous ovarian carcinoma treated at a single institution between 2008 and 2021. All patients completed 6 cycles of carboplatin- and paclitaxel-based neoadjuvant chemotherapy. The chemotherapy response score was assessed in omental and adnexal specimens and categorized as 1, 2, or 3. Tumor-infiltrating lymphocyte density in pre- and post-treatment samples was classified as low (<10%) or high (≥10%). Associations among the chemotherapy response score, CA-125 levels, tumor-infiltrating lymphocytes, and survival outcomes-including overall survival and disease-free survival-were analyzed using Kaplan-Meier estimates and Cox proportional hazards models.

Results: Of 294 patients screened, 110 met the inclusion criteria. In the omentum, 35.6% had a Chemotherapy Response Score of 3, with a median overall survival of 56.7 months (HR 0.34, 95% CI 0.19 to 0.61). In the adnexa, 43.8% had a score of 2, 41.7% had a score of 1, and 14.6% had a score of 3. Median overall survival for adnexal score 2 was 50.6 months, compared to 33.8 months for score 1. Post-treatment CA-125 levels ≤35 U/mL were associated with higher chemotherapy response score categories and improved survival (HR 0.45, 95% CI 0.28 to 0.73). Tumor-infiltrating lymphocyte density ≥10% was more frequent in adnexal score 2 cases (88.5%, p = .006), but tumor-infiltrating lymphocyte levels-both pre- and post-treatment-were not independently associated with overall survival or disease-free survival.

Conclusions: The chemotherapy response score and post-treatment CA-125 levels are independent prognostic indicators following 6 cycles of neoadjuvant chemotherapy. Tumor-infiltrating lymphocyte density showed site-specific patterns but lacked independent prognostic significance for survival outcomes.

高级别浆液性卵巢癌6周期新辅助化疗后细胞减少:化疗反应评分、CA-125和肿瘤浸润淋巴细胞对预后的影响
目的:评价新辅助化疗后肿瘤消退的组织病理学分级系统化疗反应评分、治疗后血清CA-125水平和肿瘤浸润淋巴细胞密度对高级别浆液性卵巢癌术后6个周期新辅助化疗患者的预后价值。方法:这项回顾性队列研究纳入了2008年至2021年间在同一家机构接受组织学证实的高级别浆液性卵巢癌患者。所有患者均完成了6个周期卡铂和紫杉醇为基础的新辅助化疗。在网膜和附件标本中评估化疗反应评分,并将其分类为1、2或3。治疗前后样本肿瘤浸润淋巴细胞密度均为低(结果:294例患者中,110例符合纳入标准)。在大网膜中,35.6%的化疗反应评分为3分,中位总生存期为56.7个月(HR 0.34, 95% CI 0.19至0.61)。在附件中,43.8%的人得分为2,41.7%的人得分为1,14.6%的人得分为3。附件评分2的中位总生存期为50.6个月,而评分1的中位总生存期为33.8个月。治疗后CA-125水平≤35 U/mL与较高的化疗反应评分类别和改善的生存率相关(HR 0.45, 95% CI 0.28 ~ 0.73)。肿瘤浸润性淋巴细胞密度≥10%在附件评分2的病例中更为常见(88.5%,p = 0.006),但肿瘤浸润性淋巴细胞水平(治疗前后)与总生存期或无病生存期没有独立相关性。结论:化疗反应评分和治疗后CA-125水平是新辅助化疗6个周期后的独立预后指标。肿瘤浸润淋巴细胞密度显示部位特异性模式,但对生存结果缺乏独立的预后意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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