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Response evaluation after neoadjuvant therapy: evaluation of chemotherapy response score and serological and/or radiological assessment of response in ovarian cancer patients



The chemotherapy response score (CRS) is a histopathological tool to evaluate response to neoadjuvant chemotherapy (NACT) in high-grade serous ovarian cancer (OC). We critically evaluated the clinical value of CRS and compared its predictive power to standard serological (CA125) and radiological response.


A retrospective analysis of 277 OC patients, who received primary chemotherapy, was performed. CRS, serological, and radiological findings were correlated with progression-free (PFS) and overall survival (OS).


CRS could be determined in 172 of 277 patients (62.1%). In patients with CRS3, a longer median PFS and OS was observed compared with CRS1/2 patients (31.2 vs. 18.9, P < 0.001; 55.0 vs. 36.1 months, P = 0.050). CA125 and radiological response evaluation were also predictive for PFS and OS. Patients with serological and radiological complete response showed longer PFS (23.0 vs. 14.4, P = 0.011; 21.4 vs. 9.6 months, P < 0.001) and OS (49.5 vs. 29.0, P = 0.003; 45.0 vs. 12.9 months, P < 0.001). Patients with pathological complete response (pCR) had the best median PFS (52.8 months), even compared with non-pCR CRS3 (27.8 months). In the total study cohort, serological, and radiological complete response was better at predicting PFS (hazard ratio 2.23 and 2.77).


In this study, evaluation of response to chemotherapy by CRS was not superior to conventional methods (CA125 or radiology). Independent of the evaluation method, response to NACT was predictive of PFS and OS. We observed no added value for CRS as a prognostic marker. The clinical relevance of CRS should be discussed, as no therapeutic consequences result from CRS evaluation.

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This study was not funded.

Author information




J.P.R. and T.B. wrote the manuscript. J.P.R., T.B., M.L.M., B.A., M.B., F.H., H.P., S.S., P.H., and A.d.B. collected the data. K.-U.W. performed analysis of radiological imaging. S.H. performed the histological analysis. A.d.B., P.H., and T.B. provided the study design and supervised the project. J.P.R., T.B., and A.T. performed the statistical analysis. J.P.R. and T.B. analyzed the data. All authors discussed the results, corrected, and validated the final manuscript.

Corresponding author

Correspondence to Jan Philipp Ramspott.

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Conflict of interest

J.P.R., M.L.M., A.T., K.-U.W., and S.H. have no conflict of interest to declare. T.B. has been an advisor for Tesaro and received research grant from Amgen, non-financial support from Amgen, MSD, Roche, and Tesaro, outside the submitted work. B.A. reports personal fees and non-financial support from Roche and Tesaro, personal fees from Amgen, Astra Zeneca, Clovis, and Celgene, non-financial support from PharmaMar, outside the submitted work. M.B. reports non-financial support from prIME Oncology, outside the submitted work. F.H. reports personal fees from Roche, AstraZeneca, Clovis, GSK/Tesaro, Molecular Health, non-financial support from PharmaMar, and New Oncology, outside the submitted work. H.P. reports non-financial support from Tesaro, outside the submitted work. S.S. reports personal fees from Roche, Astra Zeneca, and Clovis, personal fees and travel grants from GSK/Tesaro, and travel grants from Pharmamar, outside the submitted work. P.H. reports grants and personal fees from Astra Zeneca, Tesaro, and Roche, personal fees from Sotio, Stryker, Zai Lab, MSD, grants and personal fees from Public funding (ASCO, DKH, DFG), personal fees from Clovis, Immunogen, grants from GSK, Boehringer Ingelheim, Medac, and Genmab, outside the submitted work. A.d.B. received honoraria and particpated in advisory boards for Roche, Astra Zeneca, Clovis, Tesaro/GSK, MSD, Genmab, and Biocad, outside the submitted work.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study before treatment.

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Supplementary Information

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Supplementary file1. Supplementary Fig. 1 Progression-free survival (PFS) in patients with CRS 1/2 and serological stable disease (SD) or partial remission (PR). b Progression-free survival (PFS) in patients with CRS 3 and serological complete remission (CR). c Overall survival (OS) in patients with CRS 1/2 and serological stable disease (SD) or partial remission (PR). d Overall survival (OS) in patients with CRS 3 and serological complete remission (CR). Determination of CRS did not show any difference in PFS (P = 0.939, P = 0.218) or OS (P = 0.420, P = 0.903) compared to serological SD/PR or CR. (TIF 492 KB)

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Ramspott, J.P., Baert, T., MacKintosh, M.L. et al. Response evaluation after neoadjuvant therapy: evaluation of chemotherapy response score and serological and/or radiological assessment of response in ovarian cancer patients. Arch Gynecol Obstet 304, 1021–1032 (2021).

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  • Ovarian cancer
  • Debulking surgery
  • Chemotherapy