Validation of the histologic grading for ovarian clear cell adenocarcinoma : a retrospective multi-institutional study by the Japan clear cell carcinoma study group
Validation of the histologic grading for ovarian clear cell adenocarcinoma : a retrospective multi-institutional study by the Japan clear cell carcinoma study group
复制标题
卵巢透明细胞腺癌组织学分级的验证：日本透明细胞癌研究组的回顾性多机构研究
DOI：
10.1097/pgp.0b013e3181f71264
复制
发表时间：
2011
影响因子：
2.4
通讯作者：
Kurachi H
中科院分区：
文献类型：
--
作者：
Yamamoto S;Kurachi H
来自合作机构的150例透明细胞腺癌患者的病理切片由2名病理学家独立审查，并使用Shimizu-Silverberg和国际妇产科联合会（FIGO）分级系统对每个肿瘤进行组织学分级。对于Shimizu-Silverberg分级系统，评估了3个参数-结构模式、核多形性和有丝分裂活性，并将其评分为1至3。当这些参数的总分为3至5、6至7和8至9时，分别指定1、2和3级。FIGO分级基于腺体/乳头状生长与实体生长的比率：1级，小于5%的实体瘤; 2级，5%至50%的实体瘤; 3级，大于50%的实体瘤。两种分级分配的观察者间一致性水平一般（κ分别为0.32和0.24）。在达成共识后，Shimizu-Silverberg分级系统将82例（55%）、56例（37%）和12例（8%）肿瘤分为1级、2级和3级，FIGO分级系统分别将88例（59%）、38例（25%）和24例（16%）肿瘤分为1级、2级和3级。生存分析表明，3级肿瘤的患者，如两个分级系统所定义的，往往有一个穷人的结果，但他们之间的任何差异没有统计学意义。多因素分析显示，只有初次手术后残留肿瘤的存在是总生存率的独立预后因素。这些结果表明，2个测试的分级系统对透明细胞腺癌患者的诊断价值有限，可能需要一个更有效的分级系统。
Pathologic slides from 150 patients with clear cell adenocarcinoma from the collaborating institutions were reviewed independently by 2 pathologists, and each tumor was graded histologically using the Shimizu-Silverberg and International Federation of Gynecology and Obstetrics (FIGO) grading systems. For the Shimizu-Silverberg grading system, 3 parameters—architectural pattern, nuclear pleomorphism, and mitotic activity—were assessed and scored as 1 to 3. When the summed scores of these parameters were 3 to 5, 6 to 7, and 8 to 9, grades 1, 2, and 3 were assigned, respectively. The FIGO grade was based on the ratio of glandular/papillary growth versus solid growth: grade 1, less than 5% solid tumor; grade 2, 5% to 50% solid tumor; grade 3, greater than 50% solid tumor. Interobserver agreement levels for assignment of both gradings were fair (κ= 0.32 and 0.24, respectively). After consensus had been acquired, 82 (55%), 56 (37%), and 12 (8%) tumors were classified as grades 1, 2, and 3 by the Shimizu-Silverberg grading system, and 88 (59%), 38 (25%), and 24 (16%) were classified as grades 1, 2, and 3 by the FIGO grading system, respectively. Survival analyses indicated that patients with grade 3 tumors, as defined by both the grading systems, tended to have a poor outcome, but any differences between them were not statistically significant. Multivariate analysis showed that only the presence of residual tumor after initial surgery was an independent prognostic factor for overall survival. These results suggest that the 2 tested grading systems have limited value for the prognostication of patients with clear cell adenocarcinoma, and that a more effective grading system for this tumor may be required.