Establishment of a universal grading system for ovarian epithelial carcinoma

本研究的目的是建立一个通用的组织病理学分级系统，适用于所有组织学类型的卵巢上皮性癌（OEC）患者。我们首先证明了结构分级（由我们定义）、细胞核多形性和核分裂计数是OEC患者独立的、有统计学意义的预后变量，然后，我们对这三个变量进行评分，并将评分相加作为最终分级。评分系统如下：（主要）：腺体=1，乳头状=2，实性=3 ;核多形性：轻度=1，中度=2，显著=3 ;有丝分裂活性（最活跃区域每10个高倍视野的有丝分裂数：0-9=1，10-24=2和[大于或等于] 25=3 ; 1级=总分3-5，2级=6或7，3级=8或9。评分的重现性相当高（符合率：94%）。受试者包括538例OEC治疗癌症研究所医院。1)新的分级作为一个重要的预测总生存期的早期和晚期疾病分层的FIGO和TNM分类的所有组织学类型的OEC相结合。2)OEC分为两组，铂敏感（浆液性、过渡性和类浆液性）和铂耐药（粘液性和透明细胞）。按新分级，对初始铂类化疗（CTX）的应答（CR + PR）无显著差异。然而，CR率在高级别疾病中显著降低。此外，高级别（G3）疾病的无进展间期、进展发生率和对二线CTX的应答显著更差。这可能表明，高级别的疾病更容易发展获得性耐药，这些结果反映在OEC患者的生存率的差异，由新的级别。3)新分级也是淋巴结转移的一个重要预后因素。

The aim of the present study was to establish a universal histopathologic granding system applicable for patients with all histologic types of ovarian epithelial carcinoma(OEC). We first demonstrated that architectural grade(defined by us), nuclear pleomorphism, and mitotic counts were independent and statistically significant prognostic variables for patients with OEC.Then, we awarded points for these three variables, and summed up the scores for a final grade. The scoring system was as follows ; Architectural pattern(predominant) : Glandular=1, Papillary=2, and Solid=3 ; Nuclear pleomorphism : Slight=1, Moderate=2, and Marked =3 ; Mitotic activity(mitotic figures per 10 high-power fields in most active region : 0-9=1, 10-24=2 and 【greater than or equal】 25=3 ; Grade 1=total score 3-5, Grade 2=6 Or 7, and Grade 3=8 or 9. Reproducibility of the scoring was appreciably high (accordance rate : 94%). Subjects included are 538 patients with OEC treated in Cancer Institute Hopspital. 1)The new grade worked as a significant predictor of overall survival in both early and advanced stage disease stratified by FIGO and TNM classification for all histologic types of OEC combined. 2)OEC were classified into distinct two groups, platinum-sensitive(serous, transitional, and endometrioid) and platinum-resistant(mucinous and clear cell). No significant difference in response(CR + PR) to intial platinum-based chemotherapy(CTX) by the new grade. CR rate, however, was significantly lowered in the high-grade disease. Furthermore, progression-free interval, incidence of progression, and the response to the second line CTX was significantly worse in the high-grade (G3)disease. This may indicate that the high-grade disease is more likely to develop acquired resistance These results were reflected in the difference of survival of OEC patients by the new grade. 3)The new grade also worked as a significant prognostic factor for lymph node metastasis.