Highlights
- •In HGSOCs the definition of morphological architectural patterns and intratumor heterogeneity are useful in prognosis.
- •HGSOCs with SET features had longer overall and progression free survival
- •The Shannon diversity index (SDI) is a proposed method to measure intratumor heterogeneity.
- •In HGSOCs higher intratumor heterogeneity by SDI was a negative independent prognostic factor in patients treated with NACT.
Abstract
Objective
High grade serous ovarian carcinoma (HGSOC) is the most common type of malignant ovarian
neoplasm and the main cause of ovarian cancer related deaths worldwide. Although novel
biomarkers such as homologous recombination deficiency testing have been implemented
into the clinical decision-making algorithm since diagnosis, morphological classification
and immunohistochemistry analysis are essential for diagnostic purpose. This study
aims at identifying histologic and clinical features that can be predictive of patients'
prognosis.
Methods
Morphological and architectural characterization including SET (Solid-Endometroid-Transitional)/Classic
features was carried out in a cohort of 234 patients analyzing 695 slides. From each
slide tumor infiltrating lymphocyte (TILs), the presence of necrosis, the number of
mitoses, the presence of psammoma bodies, giant cells and atypical mitoses were recorded.
Morphological heterogeneity was quantified by the Shannon's diversity index (SDI)
considering the percentage of each architectural pattern per patient's slide.
Results
The frequency of architectural patterns and morphological variables varied with respect
of the surgical strategy (primary debulking surgery vs interval surgery after neoadjuvant
chemotherapy). HGSOCs exhibiting SET features had a longer overall as well as progression
free survival. Among SET features, pseudo-endometrioid and transitional like patterns
had the best outcome, while it was heterogenous for solid pattern, that had better
outcome for BRCA 1 negative and less heterogeneous tumors. In patients submitted to
neoadjuvant chemotherapy a higher intratumor heterogeneity as defined by SDI was a
negative independent prognostic factor.
Conclusions
A comprehensive histological examination considering architectural patterns and their
heterogeneity can help in prognostication of HGSOCs.
Keywords
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Article info
Publication history
Published online: September 30, 2021
Accepted:
September 19,
2021
Received in revised form:
August 24,
2021
Received:
January 25,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
