Abstract
BackgroundThe Cancer Genome Atlas Research Network reported that high-grade serous carcinoma (HGSC) can be classified based on gene expression profiles into four subtypes, termed “immunoreactive,” “differentiated,” “proliferative,” and “mesenchymal.” We previously established a novel histopathological classification of HGSC, corresponding to the gene expression subtypes: immune reactive (IR), papillo-glandular (PG), solid and proliferative (SP), and mesenchymal transition (MT). The purpose of this study is to identify distinct clinical findings among the four pathological subtypes of HGSC, as well as to predict pathological subtype based on preoperative images.MethodsWe retrospectively assessed 65 HGSC cases (IR: 17, PG: 7, SP: 14, MT: 27) and analyzed preoperative images.ResultsAll IR cases originated from either the ovary or fallopian tube (P = 0.0269). Significantly more IR cases were diagnosed at earlier stages (P = 0.0013), and IR cases displayed lower levels of ascites (P = 0.0014), fewer peritoneal lesions (P = 0.0080), a sporadic pattern of peritoneal lesions (P = 0.0016), a lower incidence of omental cake (P = 0.0416), and fewer distant metastases (P = 0.0146) compared with the other subtypes. MT cases were more likely to be of peritoneal origin (P = 0.0202), presented at advanced stages with higher levels of ascites (P = 0.0008, 0.0052, respectively), and more frequently had a diffuse pattern of peritoneal lesions (P = 0.0059), omental cake (P = 0.0179), and distant metastasis (P = 0.0053). A decision tree analysis estimated the histopathological subtypes based on preoperative images, with a sensitivity of 67.3%.ConclusionsPathological subtypes of HGSC have distinct clinical behaviors, and preoperative images enable better prediction of pathological subtype. These findings may lead to individualized treatment plans if the effect of treatment based on the HGSC subtype is elucidated.
Highlights
The Cancer Genome Atlas Research Network reported that high-grade serous carcinoma (HGSC) can be classified based on gene expression profiles into four subtypes, termed “immunoreactive,” “differentiated,” “proliferative,” and “mesenchymal.” We previously established a novel histopathological classification of HGSC, corresponding to the gene expression subtypes: immune reactive (IR), papillo-glandular (PG), solid and proliferative (SP), and mesenchymal transition (MT)
We recently established four histopathological classifications of HGSC that correlate with the The Cancer Genome Atlas (TCGA) gene expression subtypes and prognoses: immune reactive (IR), which is defined by lymphocytes surrounding and infiltrating the malignant tissue; papillo-glandular (PG), which is defined by a papillary architecture; solid and proliferative (SP), which is defined by a solid growth pattern; and mesenchymal transition (MT), which is defined by a remarkable desmoplastic reaction [10]
More IR cases were diagnosed at earlier stages compared with the other subtypes (8/17 vs. 4/48, P = 0.0013), and more MT cases were diagnosed at advanced stages (27/27 vs. 26/38, P = 0.0008)
Summary
The Cancer Genome Atlas Research Network reported that high-grade serous carcinoma (HGSC) can be classified based on gene expression profiles into four subtypes, termed “immunoreactive,” “differentiated,” “proliferative,” and “mesenchymal.” We previously established a novel histopathological classification of HGSC, corresponding to the gene expression subtypes: immune reactive (IR), papillo-glandular (PG), solid and proliferative (SP), and mesenchymal transition (MT). Analysis of gene expression microarray data from The Cancer Genome Atlas (TCGA) project revealed that HGSC could be classified as one of four gene expression subtypes: “immunoreactive,” “differentiated,” “proliferative,” or “mesenchymal” [6, 7] These sub-classifications display distinct prognoses and sensitivities to chemotherapy [7,8,9]. We recently established four histopathological classifications of HGSC that correlate with the TCGA gene expression subtypes and prognoses: immune reactive (IR), which is defined by lymphocytes surrounding and infiltrating the malignant tissue; papillo-glandular (PG), which is defined by a papillary architecture; solid and proliferative (SP), which is defined by a solid growth pattern; and mesenchymal transition (MT), which is defined by a remarkable desmoplastic reaction [10]. Diagnosis of these subtypes requires biopsy of the tumor, which is located in the abdominal cavity and can be difficult to access
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