Statement by the Kommission Ovar of the AGO: The New FIGO and WHO Classifications of Ovarian, Fallopian Tube and Primary Peritoneal Cancer

Abstract

More than 25 years after the last revision, in 2012 the FIGO Oncology Committee began revising the FIGO classification for staging ovarian, Fallopian tube and primary peritoneal cancers. The new classification has become effective with its publication at the beginning of 2014. Following recent findings on the pathogenesis of ovarian, Fallopian tube and primary peritoneal cancer and reflecting standard clinical practice, the three entities have now been classified uniformly. The histological subtype is included (high-grade serous – HGSC; low-grade serous – LGSC; mucinous – MC; clear cell – CCC; endometrioid – EC). Stages III and IV have been fundamentally changed: stage IIIA now refers to a localized tumor limited to the pelvis with (only) retroperitoneal lymph node metastasis (formerly classified as IIIC). Stage IV has been divided into IVA and IVB, with IVA defined as malignant pleural effusion and IVB as parenchymatous or extra-abdominal metastasis including inguinal and mediastinal lymph node metastasis as well as umbilical metastasis. A new WHO classification was published almost concurrently. The classification of serous tumors addresses the issue of the tubal carcinogenesis of serous ovarian cancer, even if no tubal precursor lesions are found for up to 30 % of serous high-grade cancers. The number of subgroups was reduced and subgroups now include only high-grade serous, low-grade serous, mucinous, seromucinous, endometrioid, clear cell and Brenner tumors. The category “transitional cell carcinomas” has been dropped and the classification “seromucinous tumors” has been newly added. More attention has been focused on the role of borderline tumors as a stage in the progression from benign to invasive lesions.

Zusammenfassung

Nach über 25 Jahren hat das FIGO Oncology Committee 2012 in Rom eine Überarbeitung der FIGO-Klassifikation zur Stadieneinteilung des Ovarialkarzinoms vorgenommen. Mit der Publikation Anfang 2014 ist die neue Klassifikation gültig. Den Erkenntnissen über die Pathogenese sowie der klinischen Praxis folgend werden das Ovarial-, das Tuben und das primäre Peritonealkarzinom einheitlich klassifiziert. Der histologische Subtyp wird angegeben (high grade serös – HGSC, low grade serös – LGSC, muzinös – MC; klarzellig – CCC und endometrioid – EC). Wesentliche Änderungen beziehen sich auf die Stadien III und IV: Stadium IIIA definiert nun einen auf das Becken beschränkten Tumor mit (ausschließlich) retroperitonealen Lymphknotenmetastasen (früher IIIC). Stadium IV wird in IVA und IVB aufgeteilt: IVA definiert einen malignen Pleuraerguss, IVB parenchymatöse oder extraabdominale Metastasen, zu denen auch die inguinalen und mediastinalen Lympknoten und die Nabelmetastasen zählen. Nahezu zeitgleich wurde auch eine neue WHO-Klassifikation publiziert. Bei den serösen Tumoren wurde auf die tubare Karzinogenese des serösen Ovarialkarzinoms eingegangen, wenn auch in bis zu 30 % der serösen High-Grade-Karzinome keine tubare Vorläuferläsion gefunden werden. Die Zahl der Subgruppen wurde auf High-grade seröse, Low-grade seröse, muzinöse, seromuzinöse, endometrioide, klarzellige Karzinome und Brenner-Tumoren reduziert. Das Transitionalzellkarzinom ist weggefallen, die seromuzinösen Tumoren sind neu. Der Rolle der Borderline-Tumoren als Progressionsstufe zwischen benignen und invasiven Läsionen wird mehr Raum gegeben.

Key words

borderline tumor - FIGO stage - ovarian cancer subtypes

Schlüsselwörter

Borderline-Tumoren (LMP) - FIGO-Stadium - Ovarialkarzinom-Subtypen

• References

• 1 Meinhold-Heerlein I, Hauptmann S. The heterogeneity of ovarian cancer. Arch Gynecol Obstet 2014; 289: 237-239
• 2 Prat J. FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124: 1-5
• 3 Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 1989; 96: 889-892
• 4 Pecorelli S, Benedet JL, Creasman WT et al. FIGO staging of gynecologic cancer. 1994–1997 FIGO Committee on Gynecologic Oncology. International Federation of Gynecology and Obstetrics. Int J Gynaecol Obstet 1999; 65: 243-249
• 5 Pecorelli S, Benedet JL, Creasman WT et al. FIGO staging of gynecologic cancer. 1994–1997 FIGO Committee on Gynecologic Oncology. International Federation of Gynecology and Obstetrics. Int J Gynaecol Obstet 1999; 64: 5-10
• 6 Przybycin CG, Kurman RJ, Ronnett BM et al. Are all pelvic (nonuterine) serous carcinomas of tubal origin?. Am J Surg Pathol 2010; 34: 1407-1416
• 7 Zeppernick F, Meinhold-Heerlein I, Shih IeM. Precursors of ovarian cancer in the fallopian tube: serous tubal intraepithelial carcinoma—an update. J Obstet Gynaecol Res 2015; 41: 6-11
• 8 Benedet JL, Bender H, Jones 3rd H et al. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet 2000; 70: 209-262
• 9 Piek JM, van Diest PJ, Zweemer RP et al. Dysplastic changes in prophylactically removed Fallopian tubes of women predisposed to developing ovarian cancer. J Pathol 2001; 195: 451-456
• 10 Meinhold-Heerlein I, Bauerschlag D, Hilpert F et al. Molecular and prognostic distinction between serous ovarian carcinomas of varying grade and malignant potential. Oncogene 2005; 24: 1053-1065
• 11 Shih IeM, Kurman RJ. Ovarian tumorigenesis: a proposed model based on morphological and molecular genetic analysis. Am J Pathol 2004; 164: 1511-1518
• 12 Kurman RJ, Shih IeM. Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer–shifting the paradigm. Hum Pathol 2011; 42: 918-931
• 13 Prat J. New insights into ovarian cancer pathology. Ann Oncol 2012; 23 (Suppl. 10) x111-x117
• 14 du Bois A, Reuss A, Pujade-Lauraine E et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: a combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: by the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe dʼInvestigateurs Nationaux Pour les Etudes des Cancers de lʼOvaire (GINECO). Cancer 2009; 115: 1234-1244
• 15 Gershenson DM, Sun CC, Bodurka D et al. Recurrent low-grade serous ovarian carcinoma is relatively chemoresistant. Gynecol Oncol 2009; 114: 48-52
• 16 Gershenson DM, Sun CC, Iyer RB et al. Hormonal therapy for recurrent low-grade serous carcinoma of the ovary or peritoneum. Gynecol Oncol 2012; 125: 661-666
• 17 Hauptmann S, du Bois A, Meinhold-Herlein I et al. [Histological grading of epithelial ovarian cancer. Review and recommendation]. Der Pathologe 2014; 35: 497-503
• 18 Hohn AK, Einenkel J, Wittekind C et al. [New FIGO classification of ovarian, fallopian tube and primary peritoneal cancer]. Der Pathologe 2014; 35: 322-326
• 19 Vergote I, De Brabanter J, Fyles A et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 2001; 357: 176-182
• 20 Paik ES, Lee YY, Lee EJ et al. Survival analysis of revised 2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification. Obstet Gynecol Sci 2015; 58: 124-134
• 21 Suh DH, Kim TH, Kim JW et al. Improvements to the FIGO staging for ovarian cancer: reconsideration of lymphatic spread and intraoperative tumor rupture. J Gynecol Oncol 2013; 24: 352-358
• 22 Kurman RJ, Carcangiu ML, Herrington CS et al. WHO Classification of Tumours of female reproductive Organs. In: Kurman RJ, Carcangiu ML, Herrington CS, et al., eds. WHO Classification of Tumours. 4th ed. Lyon: WHO Press; 2014
• 23 Hauptmann S. Die neue WHO-Klassifikation des Ovarial-, Tuben- und primären Peritonealkarzinoms. 2015.
• 24 Chene G, Ouellet V, Rahimi K et al. The ARID1A pathway in ovarian clear cell and endometrioid carcinoma, contiguous endometriosis, and benign endometriosis. Int J Gynaecol Obstet 2015; 130: 27-30
• 25 Wiegand KC, Shah SP, Al-Agha OM et al. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med 2010; 363: 1532-1543