Prognostic Role of CRS in High Grade Serous Ovarian Tumour Patients Receiving Neoadjuvant Chemotherapy in a Tertiary Care Hospital of Central India

Abstract

Introduction: Ovarian tumours are rarely diagnosed early, patients presents only when the abdominal mass is appreciable in size. The current mode of treatment involves neoadjuvant chemotherapy with interval debulking surgery, followed by completion of the chemotherapy. The pathological examination of the interval debulking specimen allows an evaluation of the extent of the response to the chemotherapy and sensitivity of the tumour to the same. The Chemotherapy Response Score (CRS) developed by Bohm S et al., is being used to predict the prognosis of these patients. The advent of molecular genetics has allowed us to categorise tumours as per the mutations they possess, the prominent in High Grade Serous Carcinoma (HGSC) being Tumour Protein 53 (TP53), Breast Carcinoma 1/2 (BRCA1/2) and Homologous Recombination Deficiency (HRD). This knowledge is used to cater to the specific therapeutic needs of the patients. Aim: To apply the CRS to cases of high grade serous carcinomas of the ovary, presenting to the centre and association of the score with their survival. Materials and Methods: This retrospective and prospective study was conducted in a tertiary care hospital, on 30 patients of high grade serous carcinoma of ovary who received neoadjuvant chemotherapy and had interval debulking surgery were included in the study. The histopathological examination of the resected specimen was done with special emphasis on the omental deposits and the degree of necrosis, fibrosis, inflammation, macrophages and residual tumour. Chi–square test was used to analyse the histopathological parameters with CRS. The p-value <0.05 was considered as statistically significant. Results: The histological parameters of necrosis, chronic inflammation and residual tumour in the omental deposits were found to be the statistically significant in association to the CRS scores. Also, the CRS grading was associated with the survival of the patients. Conclusion: The CRS was found to associate well with the survival of the patients. This study recommends that CRS score be done in all post Neoadjuvant Chemotherapy (NACT) high grade serous ovarian tumours, which will guide further treatment.

Keywords

• chemotherapy response score
• debulking surgery
• ovarian cancer