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.
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. dcbodurka@mdanderson.org
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
authors.forename: Michael T
authors.initials: MT
authors.lastname: Deavers
authors.forename: Chunqiao
authors.initials: C
authors.lastname: Tian
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.forename: Anais
authors.initials: A
authors.lastname: Malpica
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
authors.forename: Anil K
authors.initials: AK
authors.lastname: Sood
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Birrer
authors.forename: Robert
authors.initials: R
authors.lastname: Ozols
authors.forename: Rebecca
authors.initials: R
authors.lastname: Baergen
authors.forename: Robert E
authors.initials: RE
authors.lastname: Emerson
authors.forename: Margaret
authors.initials: M
authors.lastname: Steinhoff
authors.forename: Behnaz
authors.initials: B
authors.lastname: Behmaram
authors.forename: Golnar
authors.initials: G
authors.lastname: Rasty
authors.forename: David M
authors.initials: DM
authors.lastname: Gershenson
mesh_terms: D000328:Adult; D000368:Aged; D002965:Classification / Q000379:methods; D018284:Cystadenocarcinoma, Serous / Q000145:classification* / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D010051:Ovarian Neoplasms / Q000145:classification* / Q000401:mortality / Q000473:pathology; D011379:Prognosis
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