title: Distribution and case-fatality ratios by cell-type for ovarian carcinomas: a 22-year series of 562 patients with uniform current histological classification.
abstract: BACKGROUND
  Ovarian carcinoma is comprised of several different cell types reflecting different clinicopathologic features. Pathologic criteria for distinguishing cell types have evolved, and therefore non-contemporary literature on ovarian cancer may have limited current relevance. A new dualistic model of pathogenesis that distinguishes type I (endometrioid, mucinous, clear cell and low grade serous carcinomas) from type II (high grade serous carcinomas and carcinosarcomas) tumors has become widely accepted.
  
  
  METHODS
  A cohort of 562 patients with invasive ovarian carcinoma from a large community hospital practice was reviewed. Cell type, FIGO stage, mortality and interpathologist diagnostic reproducibility were analyzed.
  
  
  RESULTS
  Advanced stage ovarian carcinomas were type II in 86% of cases while low stage tumors were most often type I. Only 1.7% of type II tumors were confirmed to be stage I with comprehensive surgical staging. Type II tumors accounted for 85% of deaths, and clear cell carcinomas, 5% of deaths. Cell type-specific case-fatality ratios for type II tumors were 62% and 79% for high grade serous carcinoma and carcinosarcoma, respectively. For type I tumors, case-fatality ratios were 38%, 36%, 27% and 13% for low grade serous, clear cell, endometrioid and mucinous carcinomas, respectively. The kappa value for diagnostic reproducibility among 3 gynecologic pathologists was 0.83.
  
  
  CONCLUSIONS
  Current diagnostic criteria confirm that high grade serous carcinoma and carcinosarcoma account for the vast majority (85%) of ovarian cancer deaths. Cell type designation is highly reproducible among gynecologic pathologists. Type II tumors are rarely stage I (<2%) when comprehensively staged by a gynecologic oncologist.
authors.affiliation: Department of Pathology, Washington Hospital Center, Washington, DC, United States. Electronic address: Jeffrey.Seidman@fda.hhs.gov.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Seidman
authors.affiliation: Departments of Pathology and Obstetrics and Gynecology, the Johns Hopkins Medical Institutions, Weinberg 2242, 401 N. Broadway, Baltimore, MD 21231, United States.
authors.forename: Russell
authors.initials: R
authors.lastname: Vang
authors.affiliation: Departments of Pathology and Obstetrics and Gynecology, the Johns Hopkins Medical Institutions, Weinberg 2242, 401 N. Broadway, Baltimore, MD 21231, United States.
authors.forename: Brigitte M
authors.initials: BM
authors.lastname: Ronnett
authors.affiliation: Departments of Pathology and Obstetrics and Gynecology, the Johns Hopkins Medical Institutions, Weinberg 2242, 401 N. Broadway, Baltimore, MD 21231, United States.
authors.forename: Anna
authors.initials: A
authors.lastname: Yemelyanova
authors.affiliation: Department of Obstetrics and Gynecology, The Hospital of Central Connecticut, 100 Grand St., New Britain, CT 06050, United States.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Cosin
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D009026:Mortality; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology*; D016019:Survival Analysis
keywords: Mortality; Ovarian carcinoma; Pathogenesis; Reproducibility; Serous carcinoma; Stage