Distribution and case-fatality ratios by cell-type for ovarian carcinomas: A 22-year series of 562 patients with uniform current histological classification

Jeffrey D. Seidman, Russell S Vang, Brigitte Maria Ronnett, Anna Yemelyanova, Jonathan A. Cosin

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)336-340
Number of pages5
JournalGynecologic Oncology
Volume136
Issue number2
DOIs
StatePublished - Feb 1 2015

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Carcinoma
Carcinosarcoma
Neoplasms
Ovarian Neoplasms
Endometrioid Carcinoma
Literature
Mucinous Adenocarcinoma
Community Hospital
Cell Death
Mortality
Pathologists

Keywords

  • Mortality
  • Ovarian carcinoma
  • Pathogenesis
  • Reproducibility
  • Serous carcinoma
  • Stage

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Medicine(all)

Cite this

Distribution and case-fatality ratios by cell-type for ovarian carcinomas : A 22-year series of 562 patients with uniform current histological classification. / Seidman, Jeffrey D.; Vang, Russell S; Ronnett, Brigitte Maria; Yemelyanova, Anna; Cosin, Jonathan A.

In: Gynecologic Oncology, Vol. 136, No. 2, 01.02.2015, p. 336-340.

Research output: Contribution to journalArticle

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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.",
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