Clinical factors and biomarkers which affect a new universal grading system for ovarian epithelial carcinoma

Objective: To detect clinical factors and biomarkers which affect a new grading system for ovarian epithelial cancer that was proposed by Shimizu et al. and to analyze the impact of those factors on malignant behaviors of the tumor. Methods: Review and scoring of specimens of paraffin embedded tissues of epithelial ovarian cancer were carried out according to the new universal grading system in 110 women who underwent initial treatments including the primary operation in our university hospital between January 1990 and June 1999. As biomarkers, expression of Bcl-2, Bax, Bcl-X, and the accumulation of P53 protein were also studied immunohistochemically. Results: This grading system functioned as a prognostic indicator. Five-year survivals of the patients was 77.6, 36.3, and 17.4%, for Grade 1, Grade 2, and Grade 3, respectively. The grade was also correlated with clinical stages, histologic subtypes, operative completeness, para-aortic lymph nodes metastasis, and the expression of Bax protein, with univariate analysis. Multivariate analysis revealed histological subtypes and para-aortic lymph nodes metastasis to be important factors which affected the grading system. Conclusion: These results demonstrate that the new universal grading system is useful, and that this grading system might reflect potential of metastasis or dissemination of the ovarian cancer.