Lars-Christian Horn1, Anne Katrin Höhn2, Bettina Hentschel3, Uta Fischer2,4, Karl Bilek4, Christine E Brambs5. 1. Division of Gynecologic, Breast and Perinatal Pathology, Institute of Pathology, University Hospital Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany. hornl@medizin.uni-leipzig.de. 2. Division of Gynecologic, Breast and Perinatal Pathology, Institute of Pathology, University Hospital Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany. 3. Institute for Medical Informatics, Statistics and Epidemiology, University Leipzig, Leipzig, Germany. 4. Division of Gynecologic Oncologic Surgery, Department of Obstetrics and Gynecology (Institute of Trier), University Hospital Leipzig, Leipzig, Germany. 5. Department of Obstetrics and Gynecology, Technical University Munich, Munich, Germany.
Abstract
PURPOSE: Tumor grade is one of the more controversial factors with limited prognostic information in squamous cell carcinomas (SCC) of the uterine cervix. METHODS: Histologic slides of 233 surgically treated cervical SCC (FIGO IB1) were re-examined regarding the prognostic impact of the WHO-based grading system, using the different degree of keratinization, categorizing the tumors in G1, G2 and G3 (conventional tumor grade). RESULTS: 45.1% presented with well-differentiated tumors (G1), 29.2% with moderate (G2) and 25.8% with poor differentiation (G3). Tumor grade significantly correlated with decreased recurrence-free and overall survival. However, detailed analyses between G1- and G2-tumors failed to show any correlation with either recurrence-free or overall survival. G1- and G2-tumors were therefore merged into low-grade tumors and were compared to the high-grade group (G3-tumors). This binary conventional grading system showed an improved 5-years recurrence-free (low-grade: 90.2% vs. high-grade: 71.6%; p = 0.001) and overall survival rates (low-grade: 89.9% vs. high-grade: 71.1%; p = 0.001) for low-grade tumors. On multivariate analysis adjusted for lymph node metastasis, high-grade tumors represented a hazard ratio of 2.4 (95% CI 1.3-4.7) for reduced recurrence-free and 2.4 (95% CI 1.2-4.6) for overall survival. High-grade tumors showed a significantly higher risk for pelvic lymph node involvement [OR 2.7 (95% CI 1.4-5.5); p = 0.003]. The traditional three-tiered grading system failed to predict pelvic lymph node metastases. CONCLUSION: A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may allow a better prognostic discrimination than the traditionally used three-tiered system.
PURPOSE:Tumor grade is one of the more controversial factors with limited prognostic information in squamous cell carcinomas (SCC) of the uterine cervix. METHODS: Histologic slides of 233 surgically treated cervical SCC (FIGO IB1) were re-examined regarding the prognostic impact of the WHO-based grading system, using the different degree of keratinization, categorizing the tumors in G1, G2 and G3 (conventional tumor grade). RESULTS: 45.1% presented with well-differentiated tumors (G1), 29.2% with moderate (G2) and 25.8% with poor differentiation (G3). Tumor grade significantly correlated with decreased recurrence-free and overall survival. However, detailed analyses between G1- and G2-tumors failed to show any correlation with either recurrence-free or overall survival. G1- and G2-tumors were therefore merged into low-grade tumors and were compared to the high-grade group (G3-tumors). This binary conventional grading system showed an improved 5-years recurrence-free (low-grade: 90.2% vs. high-grade: 71.6%; p = 0.001) and overall survival rates (low-grade: 89.9% vs. high-grade: 71.1%; p = 0.001) for low-grade tumors. On multivariate analysis adjusted for lymph node metastasis, high-grade tumors represented a hazard ratio of 2.4 (95% CI 1.3-4.7) for reduced recurrence-free and 2.4 (95% CI 1.2-4.6) for overall survival. High-grade tumors showed a significantly higher risk for pelvic lymph node involvement [OR 2.7 (95% CI 1.4-5.5); p = 0.003]. The traditional three-tiered grading system failed to predict pelvic lymph node metastases. CONCLUSION: A binary grading model for the conventional tumor grade (based on the degree of keratinization) in SCC of the uterine cervix may allow a better prognostic discrimination than the traditionally used three-tiered system.
Authors: Lars-Christian Horn; Matthias W Beckmann; Markus Follmann; Martin C Koch; Monika Nothacker; Birgit Pöschel; Frederik Stübs; Dietmar Schmidt; Anne Kathrin Höhn Journal: Pathologie (Heidelb) Date: 2022-02-21