The Grading of Small Biopsy Samples of Ovarian Carcinoma: Relationship to Response to Neoadjuvant Chemotherapy
MT Galgano, KA Atkins, MH Stoler, JS Ferriss, EB Stelow. University of Virginia Health System, Charlottesville, VA
Background: Neoadjuvant chemotherapy may be employed for advanced-stage ovarian carcinomas unlikely to achieve optimal debulking at primary surgery. Initial chemotherapy with interval debulking increases the likelihood of optimal cytoreduction which is a significant prognostic feature. However, systematic grading of primary surgical specimens has demonstrated that low-grade tumors are more resistant to platinum-based therapy. The purpose of this study was to uniformly grade diagnostic biopsies of women with advanced stage ovarian cancer destined for neoadjuvant chemotherapy with interval debulking for correlation to clinical outcome.
Design: All women with ovarian carcinoma treated surgically at our institution between the years of 1995 and 2003 were retrospectively reviewed to identify those who were given neoadjuvant chemotherapy. All diagnostic material that preceded the initiation of chemotherapy were reviewed and scored by three independent cytopathologists using an adapted version of the Shimizu-Silverberg system to account for the predominance of cytology samples. Specifically, single cell pattern was interpreted as an architectural score of 3, and mitotic count was scored as 1 for zero, 2 for rare (1-2/100 cells) or 3 for numerous (>2/100 cells) mitotic figures. The scores were correlated to cytoreduction status and overall clinical outcome data.
Results: Of 200 women treated for ovarian carcinoma, 98 (49%) received primary chemotherapy, and 72 had archived slides available for review. The consensus review designated 10 grade 1, 36 grade 2, and 26 grade 3 carcinomas. Grade 1 tumors tended to have suboptimal interval debulking (3 of 10) when compared to grade 2/3 tumors (6 of 62) (p=.07). However, grade 1 tumors had a longer average post-surgical remission period of 569 days, compared to 329 days for grade 2/3 tumors (p=.045). There was no significant difference in the time to death (ave, 952 days); however, 30% of patients with grade 1 tumors had died of disease, compared to 53% of those with grade 2/3 tumors at last follow up (ave follow up, 1115 days).
Conclusions: Uniformly applying a grading system to small tissue biopsies and fluid samples for presumed high-stage ovarian carcinoma can identify low-grade lesions that have a tendency for suboptimal debulking after neoadjuvant chemotherapy. Longer remission periods after surgery may reflect slower growing tumors with fewer deaths due to disease.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 61, Wednesday Afternoon