Outcome-based Validation of Confluent/Expansile Versus Infiltrative Pattern Assessment and Growth-based Grading in Ovarian Mucinous Carcinoma
Outcome-based Validation of Confluent/Expansile Versus Infiltrative Pattern Assessment and Growth-based Grading in Ovarian Mucinous Carcinoma
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卵巢粘液癌融合/扩张与浸润模式评估和基于生长的分级的基于结果的验证
DOI：
10.1097/pas.0000000000001895
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
A. Busca
中科院分区：
文献类型：
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作者：
Amir Momeni;H. Song;L. Irshaid;S. Strickland;C. Parra‐Herran;A. Busca
原发性卵巢粘液癌（OMC）的生长模式（融合/扩张与浸润）在临床上非常重要，国际癌症报告协作组（ICCR）目前建议记录这种肿瘤类型中浸润性生长的百分比。OMC的组织学分级是有争议的，没有一种方法被世界卫生组织肿瘤分类广泛接受或目前认可。由于卵巢癌分级通常在临床决策中考虑，以前的文献建议将临床相关的肿瘤参数，如生长模式纳入OMC分级。我们在本文中验证了这种方法，称为基于增长的等级（GBG），在一个独立的，注释良好的队列从2个机构。由Silverberg、国际妇产科联合会（FIGO）和GBG方案对具有可用组织学材料的OMC进行审查和分级。GBG将OMC分类为低级别（GBG-LG，融合/膨胀性生长，或≤10%浸润性浸润）或高级别（GBG-HG，>10%肿瘤的浸润性生长）。该队列由74名OMC组成，其中53名被指定为GBG-LG，21名被指定为GBG-HG。使用Silverberg分级，该队列有42例（57%）1级、28例（38%）2级和4例（5%）3级OMC。使用FIGO分级，50例（68%）OMC为1级，23例（31%）为2级，1例（1%）为3级。68例患者的随访数据可用，其中15例（22%）癌症复发。与GBG-LG肿瘤相比，GBG-HG肿瘤更容易复发（57% vs.6%; χ2 P<0.0001）。Silverberg和FIGO分级系统在单变量分析中也与无进展生存期相关，但多变量分析显示仅GBG具有显著性（风险比：10.9;考克斯比例回归P=0.0004）。7例患者（10%）死于疾病，均患有GBG-HG（对数秩P<0.0001）。多因素分析显示浸润性生长百分比是预测疾病特异性生存率的唯一因素（风险比：25.5，考克斯P=0.02）。在GBG类别中添加核生物并不能改善分类。我们的研究验证了GBG系统对OMC无病生存期和疾病特异性生存期的预后价值，在多变量分析中，GBG系统优于Silverberg和FIGO分级。因此，GBG应该是肿瘤分级的首选方法。
The growth pattern (confluent/expansile versus infiltrative) in primary ovarian mucinous carcinoma (OMC) is prognostically important, and the International Collaboration on Cancer Reporting (ICCR) currently recommends recording the percentage of infiltrative growth in this tumor type. Histologic grading of OMC is controversial with no single approach widely accepted or currently recognized by the World Health Organization Classification of Tumours. Since ovarian carcinoma grade is often considered in clinical decision-making, previous literature has recommended incorporating clinically relevant tumor parameters such as growth pattern into the OMC grade. We herein validate this approach, termed Growth-Based Grade (GBG), in an independent, well-annotated cohort from 2 institutions. OMCs with available histologic material underwent review and grading by Silverberg, International Federation of Obstetrics and Gynecology (FIGO), and GBG schema. GBG categorizes OMCs as low-grade (GBG-LG, confluent/expansile growth, or ≤10% infiltrative invasion) or high-grade (GBG-HG, infiltrative growth in >10% of tumor). The cohort consisted of 74 OMCs, 53 designated as GBG-LG, and 21 as GBG-HG. Using Silverberg grading, the cohort had 42 (57%) grade 1, 28 (38%) grade 2, and 4 (5%) grade 3 OMCs. Using FIGO grading, 50 (68%) OMCs were grade 1, 23 (31%) grade 2, and 1 (1%) grade 3. Follow-up data was available in 68 patients, of which 15 (22%) had cancer recurrence. GBG-HG tumors were far more likely to recur compared with GBG-LG tumors (57% vs. 6%; χ2 P<0.0001). Silverberg and FIGO grading systems also correlated with progression-free survival in univariate analysis, but multivariate analysis showed only GBG to be significant (hazard ratio: 10.9; Cox proportional regression P=0.0004). Seven patients (10%) died of disease, all of whom had GBG-HG (log-rank P<0.0001). Multivariate analysis showed that the percentage of infiltrative growth was the only factor predictive of disease-specific survival (hazard ratio: 25.5, Cox P=0.02). Adding nuclear atypia to GBG categories did not improve prognostication. Our study validates the prognostic value of the GBG system for both disease-free survival and disease-specific survival in OMC, which outperformed Silverberg and FIGO grades in multivariate analysis. Thus, GBG should be the preferred method for tumor grading.