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 Emerson, Margaret Steinhoff, Behnaz Behmaram, Golnar Rasty, David M. Gershenson

Research output: Contribution to journalArticle

85 Citations (Scopus)

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 languageEnglish
Pages (from-to)3087-3094
Number of pages8
JournalCancer
Volume118
Issue number12
DOIs
StatePublished - Jun 15 2012

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Carcinoma
Disease-Free Survival
Gynecology
Neoplasms
Obstetrics
Survival
Multicenter Studies
Ovary
Histology
Multivariate Analysis
Demography
Confidence Intervals
Pathology
Drug Therapy
Population

Keywords

  • 2-tier grading system
  • Figo grading
  • Ovarian cancer
  • Serous histology

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Bodurka, D. C., Deavers, M. T., Tian, C., Sun, C. C., Malpica, A., Coleman, R. L., ... 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

Reclassification of serous ovarian carcinoma by a 2-tier system : A Gynecologic Oncology Group study. / Bodurka, Diane C.; Deavers, Michael T.; Tian, Chunqiao; Sun, Charlotte C.; Malpica, Anais; Coleman, Robert L.; Lu, Karen H.; Sood, Anil K.; Birrer, Michael J.; Ozols, Robert; Baergen, Rebecca; Emerson, Robert; Steinhoff, Margaret; Behmaram, Behnaz; Rasty, Golnar; Gershenson, David M.

In: Cancer, Vol. 118, No. 12, 15.06.2012, p. 3087-3094.

Research output: Contribution to journalArticle

Bodurka, DC, Deavers, MT, Tian, C, Sun, CC, Malpica, A, Coleman, RL, Lu, KH, Sood, AK, Birrer, MJ, Ozols, R, Baergen, R, Emerson, R, 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
Bodurka DC, Deavers MT, Tian C, Sun CC, Malpica A, Coleman RL et al. Reclassification of serous ovarian carcinoma by a 2-tier system: A Gynecologic Oncology Group study. Cancer. 2012 Jun 15;118(12):3087-3094. https://doi.org/10.1002/cncr.26618
Bodurka, Diane C. ; Deavers, Michael T. ; Tian, Chunqiao ; Sun, Charlotte C. ; Malpica, Anais ; Coleman, Robert L. ; Lu, Karen H. ; Sood, Anil K. ; Birrer, Michael J. ; Ozols, Robert ; Baergen, Rebecca ; Emerson, Robert ; Steinhoff, Margaret ; Behmaram, Behnaz ; Rasty, Golnar ; Gershenson, David M. / Reclassification of serous ovarian carcinoma by a 2-tier system : A Gynecologic Oncology Group study. In: Cancer. 2012 ; Vol. 118, No. 12. pp. 3087-3094.
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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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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

AU - Steinhoff, Margaret

AU - Behmaram, Behnaz

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AU - Gershenson, David M.

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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.

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