Tumor cell type can be reproducibly diagnosed and is of independent prognostic significance in patients with maximally debulked ovarian carcinoma
Tumor cell type can be reproducibly diagnosed and is of independent prognostic significance in patients with maximally debulked ovarian carcinoma
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DOI：
10.1016/j.humpath.2008.01.003
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发表时间：
2008-08-01
期刊：
影响因子：
3.3
通讯作者：
Swenerton, Kenneth
中科院分区：
文献类型：
--
作者：
Gilks, C. Blake;Ionescu, Diana N.;Swenerton, Kenneth
卵巢表面上皮癌通常由病理学家根据肿瘤细胞的类型和分级进行细分。在根据疾病分期分层的患者中，细胞类型或分级在预测患者对治疗或生存的反应方面是否更好仍存在争议。这项研究的目的是对一系列575例卵巢表面上皮癌统一应用最新的细胞类型和分级分配标准。所有患者均以最佳的手术方式去骨，初次手术后无肉眼残留病变。这些病例的幻灯片由一名病理学家审查，他对患者的结果视而不见。在50个病例中，另外两名病理学家独立审查了切片，以确定观察者之间在评估细胞类型和分级方面的差异。肿瘤分期分布：I期233例，II期246例，III期96例。最常见的细胞类型是浆液性癌(229/575，40%)，其次是透明细胞(149/575，26%)、子宫内膜样癌(139/575，24%)和粘液性(36/575，6%)。浆液性癌更容易出现晚期疾病(76/229[33.2%]为III期，82%的HI期肿瘤为浆液性)，而90%以上的病例诊断时所有非浆液性细胞类型均为I期或II期。FIGO分级和Silverberg分级都将患者分为复发和生存风险显著不同的组，但Silverberg分级系统是更有效的预测指标。在多因素分析中，分期是最有力的预后指标(P<；.0001)，其次是肿瘤细胞类型(P=.015)，但分级没有独立意义。观察者间细胞类型分配的变异非常好(K=0.77)，Silverberg分级的重复性中等(kappa=0.40)，FIGO分级的重复性最低(kappa=0.27)。因此，在这一系列的卵巢表面上皮癌病例中，与肿瘤分级相比，肿瘤细胞类型的分配比肿瘤分级的分配更具重复性，并提供更好的预后信息。由于肿瘤细胞类型也与潜在的分子异常相关，并可能预测对化疗的反应，这表明肿瘤细胞类型可用于指导卵巢表面上皮癌患者的治疗决策。(C)2008 Elsevier Inc.保留所有权利。
Ovarian surface epithelial carcinomas are routinely subclassified by pathologists based on tumor cell type and grade. It is controversial whether cell type or grade is superior in predicting patient response to treatment or survival, in patients stratified by stage of disease. The aim of this study was to uniformly apply updated criteria for cell-type and grade assignment to a series of 575 cases of ovarian surface epithelial carcinoma. All patients were optimally surgically debulked, with no macroscopic residual disease after primary surgery. Slides from these cases were reviewed by a single pathologist, who was blinded to patient outcomes. In 50 cases, 2 additional pathologists reviewed the slides independently to determine interobserver variation in assessment of cell type and grade. The distribution of tumor stage was as follows: stage I-233 cases, stage II-246 cases, stage III-96 cases. The most common cell type encountered was serous carcinoma (229/575, 40%), followed by clear cell (149/575, 26%), endometrioid (139/575, 24%), and mucinous (36/575, 6%). Serous carcinomas were significantly more likely to present with advanced stage disease (76/229 [33.2%] were stage III, and 82% of all stage HI tumors were serous), whereas all nonserous cell types were stage I or II at diagnosis in greater than 90% of cases. Both FIGO grade and Silverberg grade stratified patients into groups with significantly different risks of relapse and survival, but the Silverberg grading system was a more powerful prognosticator. In multivariate analysis, stage was the most powerful prognostic indicator (P < .0001), followed by tumor cell type (P = .015), but grade was not of independent significance. Interobserver variation in assignment of cell type was very good (K = 0.77) with moderate reproducibility in assignment of Silverberg grade (kappa = 0.40) and minimal reproducibility in assignment of FIGO grade (kappa = 0.27). Thus, in this series of cases of ovarian surface epithelial carcinomas with no macroscopic residual disease after primary debulking surgery, assignment of tumor cell type was both more reproducible and provided superior prognostic information compared with assignment of tumor grade. As tumor cell type also correlates with underlying molecular abnormalities and may predict response to chemotherapy, this suggests that tumor cell type could be used to guide treatment decisions for patients with ovarian surface epithelial carcinoma. (C) 2008 Elsevier Inc. All rights reserved.