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

Diane C. Bodurka; 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

doi:10.1002/cncr.26618

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

Diane C. Bodurka, 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

Department of Pathology & Genomic Medicine

Research output: Contribution to journal › Article › peer-review

139 Scopus citations

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.

Original language	English (US)
Pages (from-to)	3087-3094
Number of pages	8
Journal	Cancer
Volume	118
Issue number	12
DOIs	https://doi.org/10.1002/cncr.26618
State	Published - Jun 15 2012

Keywords

2-tier grading system
Figo grading
Ovarian cancer
Serous histology

ASJC Scopus subject areas

Oncology
Cancer Research

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10.1002/cncr.26618

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Bodurka, D. C., Deavers, M. T., Tian, C., Sun, C. C., Malpica, A., Coleman, R. L., Lu, K. H., Sood, A. K., Birrer, M. J., Ozols, R., Baergen, R., Emerson, R. E., Steinhoff, M., Behmaram, B., Rasty, G., & Gershenson, D. M. (2012). Reclassification of serous ovarian carcinoma by a 2-tier system: A Gynecologic Oncology Group study. Cancer, 118(12), 3087-3094. https://doi.org/10.1002/cncr.26618

Bodurka, DC, Deavers, MT, Tian, C, Sun, CC, Malpica, A, Coleman, RL, Lu, KH, Sood, AK, Birrer, MJ, Ozols, R, Baergen, R, Emerson, RE, Steinhoff, M, Behmaram, B, Rasty, G & Gershenson, DM 2012, 'Reclassification of serous ovarian carcinoma by a 2-tier system: A Gynecologic Oncology Group study', Cancer, vol. 118, no. 12, pp. 3087-3094. https://doi.org/10.1002/cncr.26618

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title = "Reclassification of serous ovarian carcinoma by a 2-tier system: A Gynecologic Oncology Group study",

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.",

keywords = "2-tier grading system, Figo grading, Ovarian cancer, Serous histology",

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

year = "2012",

month = jun,

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doi = "10.1002/cncr.26618",

language = "English (US)",

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T1 - Reclassification of serous ovarian carcinoma by a 2-tier system

T2 - A Gynecologic Oncology Group study

AU - Bodurka, Diane C.

AU - Deavers, Michael T.

AU - Tian, Chunqiao

AU - Sun, Charlotte C.

AU - Malpica, Anais

AU - Coleman, Robert L.

AU - Lu, Karen H.

AU - Sood, Anil K.

AU - Birrer, Michael J.

AU - Ozols, Robert

AU - Baergen, Rebecca

AU - Emerson, Robert E.

AU - Steinhoff, Margaret

AU - Behmaram, Behnaz

AU - Rasty, Golnar

AU - Gershenson, David M.

PY - 2012/6/15

Y1 - 2012/6/15

N2 - 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.

AB - 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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KW - Figo grading

KW - Ovarian cancer

KW - Serous histology

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

Abstract

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