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Pathological chemotherapy response score is prognostic in tubo-ovarian high-grade serous carcinoma: A systematic review and meta-analysis of individual patient data

Authors
 Paul A.Cohen  ;  AimePowell  ;  SteffenBöhm  ;  C.BlakeGilks  ;  ColinJ.R.Stewart  ;  TarekM.Meniawy  ;  MaxBulsara  ;  StefanieAvril  ;  EleanorC.Brockbank  ;  TjallingBosse  ;  Gustavo RubinodeAzevedoFocchi  ;  RajiGanesan  ;  RosalindM.Glasspool  ;  BrookeE.Howitt  ;  Hyun-Soo Kim  ;  Jung-Yun Lee  ;  NhuD.Le  ;  MichelleLockley  ;  RanjitManchanda  ;  TruptiMandalia  ;  W.GlennMcCluggage  ;  IainMcNeish  ;  DivyaMidha  ;  RadhikaSrinivasan  ;  YunYiTan  ;  RachaelvanderGriend  ;  MayuYunokawa  ;  GianF.Zannoni  ;  The HGSCCRS Collaborative Network Takahiro Ebata af  ;  NaveenaSingh ag  ;  KenjiTamura ag  ;  HiroshiYoshida 
Citation
 GYNECOLOGIC ONCOLOGY, Vol.154(2) : 441-448, 2019 
Journal Title
 GYNECOLOGIC ONCOLOGY 
ISSN
 0090-8258 
Issue Date
2019
Keywords
Chemotherapy response score ; High-grade serous tubo-ovarian cancer ; Neoadjuvant chemotherapy ; Prognosis
Abstract
OBJECTIVE: There is a need to develop and validate biomarkers for treatment response and survival in tubo-ovarian high-grade serous carcinoma (HGSC). The chemotherapy response score (CRS) stratifies patients into complete/near-complete (CRS3), partial (CRS2), and no/minimal (CRS1) response after neoadjuvant chemotherapy (NACT). Our aim was to review current evidence to determine whether the CRS is prognostic in women with tubo-ovarian HGSC treated with NACT. METHODS: We established an international collaboration to conduct a systematic review and meta-analysis, pooling individual patient data from 16 sites in 11 countries. Patients had stage IIIC/IV HGSC, 3-4 NACT cycles and >6-months follow-up. Random effects models were used to derive combined odds ratios in the pooled population to investigate associations between CRS and progression free and overall survival (PFS and OS). RESULTS: 877 patients were included from published and unpublished studies. Median PFS and OS were 15 months (IQR 5-65) and 28 months (IQR 7-92) respectively. CRS3 was seen in 249 patients (28%). The pooled hazard ratios (HR) for PFS and OS for CRS3 versus CRS1/CRS2 were 0·55 (95% CI, 0·45-0·66; P < 0·001) and 0·65 (95% CI 0·50-0·85, P = 0·002) respectively; no heterogeneity was identified (PFS: Q = 6·42, P = 0·698, I2 = 0·0%; OS: Q = 6·89, P = 0·648, I2 = 0·0%). CRS was significantly associated with PFS and OS in multivariate models adjusting for age and stage. Of 306 patients with known germline BRCA1/2 status, those with BRCA1/2 mutations (n = 80) were more likely to achieve CRS3 (P = 0·027). CONCLUSIONS: CRS3 was significantly associated with improved PFS and OS compared to CRS1/2. This validation of CRS in a real-world setting demonstrates it to be a robust and reproducible biomarker with potential to be incorporated into therapeutic decision-making and clinical trial design.
Files in This Item:
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DOI
10.1016/j.ygyno.2019.04.679
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyun-Soo(김현수)
Lee, Jung-Yun(이정윤) ORCID logo https://orcid.org/0000-0001-7948-1350
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174579
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