Chemotherapy-associated foam cell aggregates as a prognostic factor in patients with pelvic high-grade serous carcinoma
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ORIGINAL ARTICLE
Chemotherapy-associated foam cell aggregates as a prognostic factor in patients with pelvic high-grade serous carcinoma receiving neo-adjuvant chemotherapy Naoki Kojima 1
&
Ikumi Kuno 2 & Takeshi Ushigusa 1 & Tomoyasu Kato 2 & Hiroshi Yoshida 1
Received: 25 December 2019 / Revised: 28 January 2020 / Accepted: 13 February 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract High-grade serous carcinoma (HGSC) tends to recur after treatment; therefore, the Chemotherapy Response Score (CRS) has been proposed as a histopathological prognostic scoring system for measuring the response to neo-adjuvant chemotherapy and the risk of recurrence. This study aimed to evaluate the CRS in only those with an R0 debulking status and to investigate new prognostic factors for progression-free survival (PFS). We reviewed the CRS of HGSC patients with R0 using surgical specimens of the omental sections. Patients were categorized according to foam cell change (FCC), defined as foam cells occupying more than half of the area of the chemotherapy-associated scar. In total, 100 HGSC patients were evaluated. PFS was significantly different according to the CRS. For CRSs of 1/2 and 3, the median PFS were 18 and 27 months, respectively (HR, 1.84; 95% CI 1.01–3.33, p = 0.045). Moreover, the FCC group showed significantly longer PFS than did the non-FCC group (20 vs 59 months; HR 2.43; 95% CI 1.15–5.14; p = 0.020). The present study validated the CRS of those in the R0 cohort. Furthermore, an increase in foam cells in the regression scar reflects the chemotherapy response and the FCC may be a useful novel prognostic factor for patients undergoing R0 resection. This finding must be further validated independently. Keywords High-grade serous carcinoma . Neo-adjuvant chemotherapy . Chemotherapy Response Score . Foam cell . Macrophage . Prognostic factor
Introduction High-grade serous carcinoma (HGSC) derived from the ovary, fallopian tube, and peritoneum is often diagnosed in the advanced stage and tends to recur after treatment, which generally involves debulking surgery and platinum-based chemotherapy. Recently, dividing adjuvant chemotherapy before and after surgery has become a standard clinical practice [1–3]. The primary prognostic factor of advanced ovarian cancer is gross residual tumour tissue following primary debulking Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00428-020-02778-9) contains supplementary material, which is available to authorized users. * Hiroshi Yoshida [email protected] 1
Department of Diagnostic Pathology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
2
Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
surgery. This recent treatment strategy enables clinicians to determine the therapeutic effect and to predict the prognosis using specimens obtained via debulking surgery. The Chemotherapy Response Score (CRS) has been proposed for measuring response to neo-adjuvant c
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