Sao Paulo Medical Journal

Prognostic value of chemotherapy response score in advanced ovarian cancer: a single-center retrospective analysis

ABSTRACT BACKGROUND: The chemotherapy response score (CRS) is a histopathological tool used to assess the tumor response in patients with high-grade serous ovarian carcinoma (HGSC) undergoing neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). DESIGN AND SETTING: This single-center retrospective study was conducted at the Faculty of Medicine at Istanbul University. The study included patients treated between January 1, 2010, and December 31, 2017 at a tertiary care hospital specializing in gynecologic oncology. OBJECTIVES: This study aimed to evaluate the prognostic significance of omental and adnexal CRS in predicting overall survival (OS) and disease-free survival (DFS) in patients with advanced HGSC undergoing NACT followed by IDS. METHODS: Data from 79 patients with advanced HGSC treated with NACT followed by IDS between 2010 and 2017 were analyzed. CRS was applied to both omental and adnexal samples, and its association with OS and DFS was evaluated. Statistical analyses were performed using univariate and multivariate methods with a significance level of P < 0.05. RESULTS: Omental CRS 1-2 was identified as an independent predictor of decreased OS (hazard ratio 2.69; 95% confidence interval 1.26–5.76, P = 0.010), whereas adnexal CRS 1-2 did not significantly impact DFS or OS in multivariate analysis. Patients with omental CRS 3 had superior outcomes, with a 5-year OS rate of 72%, compared to 30.8% in the CRS 1–2 group. The median DFS of the CRS 1–2 group was 19 months, whereas that of the CRS 3 group was 35 months (P = 0.005). CONCLUSIONS: Omental CRS is a strong independent predictor of OS in patients with advanced HGSC, whereas adnexal CRS has limited prognostic value. CRS should be considered in clinical practice to guide treatment decisions, and further research is warranted to refine its use by using molecular and radiological markers.

Accuracy of endocervical cytological tests in diagnosing preinvasive lesions of the cervical canal in patients with type 3 transformation zone: a retrospective observational study

Cervical cancer screening in Brazil is done using Pap smears. Women who are most likely to have a preinvasive lesion or cervical cancer are immediately referred for colposcopy. The aim of this study was to evaluate the diagnostic performance of endocervical cytological tests in diagnosing preinvasive cervical lesions in women with initial high-grade squamous intraepithelial lesions (HSIL), or atypical squamous cells in which high-grade lesions could not be ruled out (ASC-H), or atypical glandular cells (AGC), and whose colposcopy did not show any abnormalities, with no fully visible transformation zone (types 2 and 3). Retrospective observational study conducted in Rio de Janeiro, Brazil. Data from women who came to the cervical pathology outpatient clinic between January 2012 and April 2017 were analyzed. The results from endocervical cytological tests were compared with the final diagnosis, which was obtained through examination of a surgical specimen or, among women who did not undergo an excisional procedure, after cytological and colposcopic follow-up for two years. We included 78 women. The sensitivity of endocervical cytological tests was 72.7%; specificity 98.5%; positive and negative predictive values 88.9% and 95.6%, respectively; and positive and negative likelihood ratios 48.7 and 0.28. Endocervical cytological tests are simple, inexpensive and noninvasive, and form a reliable method for determining management among patients with HSIL, ASC-H and AGC cytological findings and negative colposcopic findings without visualization of the squamocolumnar junction.

Implementation of a new histological grading system in ovarian mucinous carcinomas and its association with the risk of recurrence: a retrospective cohort study

ABSTRACT BACKGROUND: This retrospective cohort study evaluated the prognostic significance of the GrowthBased Grade (GBG) system compared to International Federation of Gynecology and Obstetrics (FIGO) grading in ovarian mucinous carcinoma (OMC). Although FIGO grading is commonly used, its prognostic value remains controversial. The GBG system, which classifies tumors as low-grade (G1) or high-grade (G2) based on the proportion of infiltrative growth, has emerged as a potential prognostic tool. OBJECTIVES: To assess the prognostic significance of GBG and compare it with FIGO grading in OMC. DESIGN AND SETTING: This retrospective cohort study included 37 women with OMC treated at a single institution between 2009 and 2022. METHODS: GBG was determined by a histopathological review of hematoxylin and eosin-stained slides. Clinical and demographic data, including FIGO stage, CA125 levels, surgical procedures, and follow-up information, were collected. Kaplan-Meier analysis and Cox regression were used to assess the associations between GBG grading, FIGO stage, and survival outcomes. RESULTS: GBG 2 tumors were significantly associated with elevated CA125 levels, advanced FIGO stage (III), and bilaterality. Multivariate analysis showed that GBG 2 conferred a 5.4-fold higher risk of recurrence compared with GBG 1. While FIGO stage III was predictive of overall survival, FIGO grading was not associated with recurrence risk. CONCLUSION: This study suggests a potential prognostic value of the GBG system in mucinous ovarian carcinoma. GBG 2 tumors showed a higher risk of recurrence than GBG 1 tumors, whereas FIGO grading showed no such association. These findings align with previous reports and should be interpreted in the context of additional studies to clarify the system’s clinical relevance.