| Research Abstract |
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.
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