Ovarian cancer is the leading cause of death in gynaecology malignancies. Neoadjuvant chemotherapy (NACT) is currently recommended in advanced ovarian cancer to achieve R0 resection in interval debulking surgery. Morphological changes in tumour cells following NACT have been studied since few years. The present study will be emphasising on five histopathological criteria: fibrosis, necrosis, inflammation, psammoma bodies, residual tumour and their impact on DFS (disease-free survival) and OS (overall survival) in this short period of time.

All histologically proven cases of carcinoma ovary of FIGO class III–IVA, where primary cytoreduction seemed not possible due to various reasons were included in the study: NACT followed by IDS. Five criteria used to evaluate chemotherapy response on tumour tissue were necrosis, fibrosis, inflammation, psammoma bodies and residual tumour. Scoring was done of each parameter. Patients’ follow-up data were evaluated for around mean follow-up period of 12–13 months to see recurrence, time of recurrence to see DFS period, time of death and complete response time.

The present study revealed the following morphological changes in most patients—severe fibrosis (83%), mild necrosis (86%), mild inflammation (80%) and minimum residual tumour (63%). Psammoma bodies were present in 10% of patients only. Patients exhibiting severe fibrosis, mild inflammation, mild necrosis and the minimum residual tumour had overall longer DFS and OS.

To our knowledge, this is the first study from North India to highlight the importance of the scoring gradation system to evaluate the pathological response of NACT in EOC. Patients with severe fibrosis, higher necrosis and less residual tumour in advanced ovarian cancer after neoadjuvant therapy have an impact on disease outcome. Further studies are needed on a large-scale basis to evaluate and formulate a gradation system for evaluating morphological changes following NACT in EOC so that the exact nature of the disease can be determined along with prognostication of the patient’s survival.