Establishment of a universal grading system for ovarian epithelial carcinoma

本研究的目的是建立一个适用于卵巢上皮性癌（OEC）所有组织学类型患者的通用组织病理学分级系统。我们首先证明了建筑分级（由我们定义）、核多形性和有丝分裂计数是OEC患者独立且具有统计学意义的预后变量。然后，我们为这三个变量打分，并将分数总结为最终成绩。评分制度如下：建筑形态（主要）：腺状=1，乳头状=2，实状=3；核多形性：轻度=1，中度=2，标记=3；有丝分裂活性(最活跃区域每10个高倍视场的有丝分裂数：0-9= 1,10 -24=2，【大于等于】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%）。纳入的研究对象是538例在肿瘤研究所医院接受治疗的OEC患者。1)新的分级对所有组织学类型的OEC合并进行FIGO和TNM分级，可作为早期和晚期疾病总生存的重要预测指标。2)OEC分为铂敏感组（浆液性、移行性和子宫内膜样）和铂耐药组（粘液性和透明细胞）。新分级对初始铂基化疗（CTX）的反应（CR + PR）无显著差异。然而，在高级别疾病中，CR率显著降低。此外，在高级别（G3）疾病中，无进展间隔、进展发生率和对二线CTX的反应明显更差。这可能表明高级别疾病更容易产生获得性耐药，这些结果反映在OEC患者的生存差异中。3)新的分级也可作为淋巴结转移的重要预后因素。

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.