Chemotherapy Response Score Following Neoadjuvant Chemotherapy and its Association with Surgical Outcome and Early Prognosis in Advanced Epithelial Ovarian Cancer: A Single-Center Study

Abstract

Background: Chemotherapy response score (CRS) is a histopathologic measure of tumor regression following neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer. Evidence from resource-limited settings remains limited. This study aimed to evaluate the association of CRS with surgical cytoreduction, platinum resistance, disease progression, and survival following NACT and interval debulking surgery (IDS).

Methods: This prospective observational cohort included 153 women with FIGO stage III–IV epithelial ovarian cancer treated at NICRH, Dhaka, from January 2017 to December 2019, with follow-up through December 2022. All patients received paclitaxel–carboplatin NACT followed by IDS. CRS was assigned using a three-tier system and categorized as CRS 1–2 versus CRS 3. Group comparisons were performed using t-tests and chi-square or Fisher’s exact tests. Logistic regression assessed progression at 1 and 3 years, while progression-free survival (PFS) was analyzed using Kaplan–Meier curves with log-rank testing.

Results: Among 153 patients, 126 were CRS 1–2 and 27 were CRS 3. R0 resection was achieved in 88.9% of CRS 3 compared with 35.7% of CRS 1–2 (p < 0.001). Platinum resistance occurred in 54.8% of CRS 1–2 and none in CRS 3 (p < 0.001). One- and three-year survival rates were significantly higher in CRS 3. CRS 1–2 and residual disease independently predicted progression, while PFS was significantly improved in CRS 3.

Conclusion: CRS is a strong predictor of cytoreduction, platinum sensitivity, progression risk, and survival outcomes after NACT–IDS in advanced ovarian cancer.