Neoadjuvant chemotherapy for high-grade serous ovarian cancer: radiologic-pathologic correlation of response assessment and predictors of progression

Molly E Roseland; Tianwen Ma; Kimberly L Shampain; Erica B Stein; Ashish P Wasnik; Nicole E Curci; Andrew P Sciallis; Shitanshu Uppal; Timothy D Johnson; Katherine E Maturen

doi:10.1007/s00261-024-04215-w

Neoadjuvant chemotherapy for high-grade serous ovarian cancer: radiologic-pathologic correlation of response assessment and predictors of progression

Abdom Radiol (NY). 2024 Mar 13. doi: 10.1007/s00261-024-04215-w. Online ahead of print.

Authors

Affiliations

¹ Department of Radiology (Divisions of Abdominal Radiology and Nuclear Medicine), Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr. B1D502, Ann Arbor, MI, 48109, USA. mollyroselandmd@gmail.com.
² School of Public Health, University of Michigan, Ann Arbor, MI, USA.
³ Department of Radiology (Divisions of Abdominal Radiology and Nuclear Medicine), Michigan Medicine, University of Michigan, 1500 E. Medical Center Dr. B1D502, Ann Arbor, MI, 48109, USA.
⁴ Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA.
⁵ Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
⁶ Department of Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.

PMID: 38478037
DOI: 10.1007/s00261-024-04215-w

Abstract

Purpose: Neoadjuvant chemotherapy is often administered for high-grade serous ovarian carcinoma (HGSC) prior to cytoreductive surgery. We evaluated treatment response by CT (simplified peritoneal carcinomatosis index [S-PCI]), pathology (chemotherapy response score [CRS]), laboratory markers (serum CA-125), and surgical outcomes, to identify predictors of disease-free survival.

Methods: For this retrospective, HIPAA-compliant, IRB-approved study, we identified 396 women with HGSC receiving neoadjuvant chemotherapy between 2010 and 2019. Two hundred and ninety-nine patients were excluded (surgery not performed; imaging/pathology unavailable). Pre- and post-treatment abdominopelvic CTs were assigned CT S-PCI scores 0-24 (higher score indicating more tumor). Specimens were assigned CRS of 1-3 (minimal to complete response). Clinical data were obtained via chart review. Univariate, multivariate, and survival analyses were performed.

Results: Ninety-seven women were studied, with mean age of 65 years ± 10. Interreader agreement was good to excellent for CT S-PCI scores (ICC 0.64-0.77). Despite a significant decrease in CT S-PCI scores after treatment (p < 0.001), mean decrease in CT S-PCI did not differ significantly among CRS categories (p = 0.20) or between patients who were optimally versus suboptimally debulked (p = 0.29). In a survival analysis, lower CRS (more viable tumor) was associated with shorter time to progression (p < 0.001). A joint Cox proportional-hazard models showed that only residual pathologic disease (CRS 1/2) (HR 4.19; p < 0.001) and change in CA-125 (HR 1.79; p = 0.01) predicted progression.

Conclusion: HGSC response to neoadjuvant therapy by CT S-PCI did not predict pathologic CRS score, optimal debulking, or progression, revealing discordance between imaging, pathologic, biochemical, and surgical assessments of tumor response.

Keywords: CT imaging; Carcinomatosis; Ovarian cancer; Serous carcinoma.