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. 2012 Jun 15;118(12):3087-94.
doi: 10.1002/cncr.26618. Epub 2011 Nov 9.

Reclassification of serous ovarian carcinoma by a 2-tier system: a Gynecologic Oncology Group Study

Diane C Bodurka  1 , Michael T Deavers, Chunqiao Tian, Charlotte C Sun, Anais Malpica, Robert L Coleman, Karen H Lu, Anil K Sood, Michael J Birrer, Robert Ozols, Rebecca Baergen, Robert E Emerson, Margaret Steinhoff, Behnaz Behmaram, Golnar Rasty, David M Gershenson
Affiliations

Reclassification of serous ovarian carcinoma by a 2-tier system: a Gynecologic Oncology Group Study

Diane C Bodurka et al. Cancer. .

Abstract

Background: A study was undertaken to use the 2-tier system to reclassify the grade of serous ovarian tumors previously classified using the International Federation of Gynecology and Obstetrics (FIGO) 3-tier system and determine the progression-free survival (PFS) and overall survival (OS) of patients treated on Gynecologic Oncology Group (GOG) Protocol 158.

Methods: The authors retrospectively reviewed demographic, pathologic, and survival data of 290 patients with stage III serous ovarian carcinoma treated with surgery and chemotherapy on GOG Protocol 158, a cooperative multicenter group trial. A blinded pathology review was performed by a panel of 6 gynecologic pathologists to verify histology and regrade tumors using the 2-tier system. The association of tumor grade with PFS and OS was assessed.

Results: Of 241 cases, both systems demonstrated substantial agreement when combining FIGO grades 2 and 3 (overall agreement, 95%; kappa statistic, 0.68). By using the 2-tier system, patients with low-grade versus high-grade tumors had significantly longer PFS (45.0 vs 19.8 months, respectively; P = .01). By using FIGO criteria, median PFS for patients with grade 1, 2, and 3 tumors was 37.5, 19.8, and 20.1 months, respectively (P = .07). There was no difference in clinical outcome in patients with grade 2 or 3 tumors in multivariate analysis. Woman with high-grade versus low-grade tumors demonstrated significantly higher risk of death (hazard ratio, 2.43; 95% confidence interval, 1.17-5.04; P = .02).

Conclusions: Women with high-grade versus low-grade serous carcinoma of the ovary are 2 distinct patient populations. Adoption of the 2-tier grading system provides a simple yet precise framework for predicting clinical outcomes.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES

The authors made no disclosures.

Figures

Figure 1
Figure 1
Low-grade serous carcinoma of the ovary is characterized by relative uniformity of the cells and up to 12 mitoses per 10 high-power fields. Courtesy of Anais Malpica, MD.
Figure 2
Figure 2
High-grade serous carcinoma of the ovary is characterized by pleomorphism; there is marked nuclear atypia and >12 mitoses per 10 high-power fields. Courtesy of Anais Malpica, MD.
Figure 3
Figure 3
(Top) Kaplan-Meier estimate of progression-free survival by 2-tier grade is shown. NP, no disease progression; P, progression of disease. (Bottom) Kaplan-Meier estimate of overall survival by The University of Texas MD Anderson Cancer Center 2-tier grade is shown.
Figure 4
Figure 4
(Top) Kaplan-Meier estimate of progression-free survival is shown by Federation of Gynecology and Obstetrics (FIGO) grade. NP, no disease progression; P, progression of disease. (Bottom) Kaplan-Meier estimate of overall survival is shown by FIGO grade.
See this image and copyright information in PMC

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