Chemotherapy response score as a prognostic tool in patients with advanced stage endometrial carcinoma treated with neoadjuvant chemotherapy
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Ina Jani1,
Ricardo R Lastra2,
Katherine S Brito3,
Chuanhong Liao4,
Isabel Lazo1,
Nita Karnik Lee1,
S Diane Yamada1 and
Katherine C Kurnit1
1Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois, USA
2Department of Pathology, University of Chicago, Chicago, Illinois, USA
3Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
4Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
Correspondence to Dr Katherine C Kurnit, Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL 60637, USA; kkurnit{at}bsd.uchicago.edu
Background Chemotherapy response score (CRS) applied to interval debulking specimens quantifies histopathologic response to neoadjuvant chemotherapy in patients with advanced ovarian carcinoma and correlates with progression-free and overall survival.
Objective To investigate whether the chemotherapy response score could be applied to interval debulking specimens in patients with advanced endometrial carcinoma and be a prognostic indicator.
Methods The study included patients with clinical stage III–IV endometrial carcinoma who received neoadjuvant chemotherapy followed by interval debulking surgery. Chemotherapy response scores were assigned to omental and adnexal metastases, and categorized as no/minimal (CRS1), partial (CRS2), and complete/near-complete (CRS3) response to neoadjuvant chemotherapy. Descriptive statistics were used to evaluate baseline characteristics and feasibility of chemotherapy response score assessment. Univariate analyses were used to evaluate associations between the chemotherapy response score, complete cytoreduction, and survival.
Results This study included 40 patients. The median age was 63.5 years, and 31 patients (78%) had stage IV disease. Thirty patients had an omentectomy, 22 patients (73%) had an omental chemotherapy response score assigned. Thirty-nine patients had a bilateral salpingo-oophorectomy, 28 patients (72%) had an adnexal chemotherapy response score assigned. Omental CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.18, p<0.01; CRS3: HR=0.11, p<0.01) and overall survival (CRS2: HR=0.10, p<0.01; CRS3: HR=0.16, p=0.04). Adnexal CRS2 and CRS3 were associated with improved progression-free survival (CRS2: HR=0.23, p<0.01; CRS3: HR=0.20, p=0.03). Chemotherapy response scores were also associated with an increased likelihood of having a complete cytoreduction.
Conclusion Chemotherapy response score can be applied to omental and adnexal metastases in patients with advanced endometrial carcinoma and was associated with survival and complete cytoreduction. The score may be a prognostic indicator and help to guide first-line treatment of patients with endometrial carcinoma.
endometrial neoplasms
cytoreduction surgical procedures
Data are available upon reasonable request. In accordance with the journal's guidelines, we will provide the data for our study if requested by other centers for an assessment of reproducibility.
http://dx.doi.org/10.1136/ijgc-2020-002202
Contributors All authors provided substantial contribution to the study and are in agreement with all the aspects of the final manuscript. Conception, design, methodology: IJ, SDY, KCK. Investigation, data acquisition and curation: IJ, KB, IL. Pathology review: RRL. Statistical analysis and methodology: CL. Drafting of the manuscript: IJ, SDY, KCK. Editing: all authors. Resources: SDY. Supervision: SDY, KCK.
Funding The study was supported by philanthropic endometrial cancer research funds to SDY.
Competing interests SDY has received clinical trial funding from LEAP Therapeutics. KCK has received funding from LEAP Therapeutics (advisory board).