Grading of ovarian carcinomas

Grading of ovarian carcinomas can have important implications for therapeut ic decisions, in particular in International Federation of Gynecology and O bstetrics (FIGO) stage I. However, there are no universally accepted gradin g guidelines for this type of cancer. We applied the grading system suggest ed by Shimizu et al. (1) to a series of ovarian carcinomas from a single in stitution to evaluate its prognostic significance in relation to other pred ictive factors. One hundred ninety-two cases of ovarian carcinomas were stu died. including all major histologic types. The histologic slides were eval uated with regard to architecture (glandular = 1 point, papillary = 2 point s, solid = 3 points), nuclear pleomorphism (nuclear variability less than o r equal to 2:1 = 1 point, intermediate nuclei = 2 points, nuclear variabili ty greater than or equal to 4:1 = 3 points), and mitotic activity per 10 hi gh-power fields using objective 40 x, ocular 10 x/20 (0-7 mitoses = 1 point , 8-18 mitoses = 2 points, greater than or equal to 9 mitoses = 3 points). Carcinomas with a total score of 3-5 points were designated as grade I, 6-7 points were designated as grade II, and 8-9 points were designated as grad e Iii. Kaplan-Meier curves showed the following 5-year survival rates: grad e I (n = 42) 88%, grade II (n = 98) 60%, grade III (n = 52) 38% (p < 0.0001 ); stage I 90%, stage n 60%, stage III 38%, stage IV 10% (p < 0.0001); resi dual disease less than or equal to 2 cm 67% and greater than or equal to 2 cm 27% (p < 0.0001). Multivariate Cox analysis revealed that grade (p < 0.0 002), as well as nuclear pleomorphism alone (p < 0.0001), both provided sta tistically significant independent prognostic information. Our observations showed that the grading system used can be easily applied to all histologi c types of ovarian carcinomas yielding prognostically relevant information and can be incorporated into routine diagnostic practice.