卵巢浆液性癌的两级分级系统及其临床意义张静郭晓青Jing-songLIU卵巢癌病死率居妇科恶性肿瘤之首，2010年美国因卵巢癌死亡患者为13850例，尽管目前手术技巧已日臻成熟，加之铂类、紫杉醇类以及二线化疗药物的辅助应用，但30年来，卵巢癌患者的5年生存率也仅从37％提高至46％[1]。卵巢浆液性癌(ovarianserouscarcinoma，OSC)是卵巢癌最常见的组织学类型，近10年来，随着临床病理学和分子遗传学研究的进一步深入，由美国德州大学M.D.安德森癌症中心(TheUniversityofTexasM.D.AndersonCancerCenter，MDACC)首先提出的OSC的组织学分级——两级分级系统(two-tiergradingsystem)已逐渐被广泛采用[2]，该分级系统对OSC的发生机制、预后判断、治疗等方面具有重要的临床意义。10.3760/cma.j.issn.0529-567x.2011.10.00577030Houston,DepartmentofPathology,TheUniversityofTexasM.D.AndersonCancerCenter，USA;张静（现在西安，第四军医大学西京医院病理科)710032;郭晓青（现在石河子大学医学院第一附属医院妇产科)832008;Jing-songLIU万方数据·740.万方数据@@[1]JemalA,SiegelR,XuJ,etal.Cancerstatistics,2010.CACancerJClin,2010,60:277-300.@@[2]MalpicaA,DeaversMT,LuK,etal.Gradingovarianserouscarcinomausingatwo-tiersystem.AmJSurgPathol,2004,28:496-504.@@[3]TavassoliFA,DevileeP.Pathologyandgeneticsoftumoursofthebreastandfemalegenitalorgans.Lyon:IARCPress,2003:119-124.@@[4]Classificationandstagingofmalignanttunoursinthefemalepelvis.ActaObstetGynecolScand,1971,50:1-7.@@[5]ShimizuY,KamoiS,AmadaS,etal.Towardthedevelopmentofauniversalgradingsystemforovarianepithelialcarcinoma.Ⅰ.Prognosticsignificanceofhistopathologicfeatures:problemsinvolvedinthearchitecturalgradingsystem.GynecolOncol,1998,70:2-12.@@[6]SilverbergSG.Histopathologicgradingofovariancarcinoma:areviewandproposal.IntJGynecolPathol,2000,19:7-15.@@[7]VangR,ShihIeM,KurmanRJ.Ovarianlow-gradeandhigh-gradeserouscarcinoma:pathogenesis,clinicopathologicandmolecularbiologicfeatures,anddiagnosticproblems.AdvAnatPatho1,2009,16:267-282.@@[8]MalpicaA,DeaversMT,TornosC,etal.Interobserverandintraobservervariabilityofatwo-tiersystemforgradingovarianserouscarcinoma.AmJSurgPathol,2007,31:1168-1174.@@[9]SingerG,OldtR3rd,CohenY,etal.MutationsinBRAFandKRAScharacterizethedevelopmentoflow-gradeovarianserouscarcinoma.JNatlCancerInst,2003,95:484-486.@@[10]SingerG,ShihIeM,TruskinovskyA,etal.MutationalanalysisofK-rassegregatesovarianserouscarcinomasintotwotypes:invasiveMPSC(low-gradetumor)andconventionalserouscarcinoma(high-gradetumor).IntJGynecolPathol,2003,22:37-41.@@[11]HoCL,KurmanRJ,DehariR,etal.MutationsofBRAFandKRASprecedethedevelopmentofovarianserousborderlinetumors.CancerRes,2004,64:6915-6918.@@[12]AnglesioMS,ArnoldJM,GeorgeJ,etal.MutationofERBB2providesanovelalternativemechanismfortheubiquitousactivationofRAS-MAPKinovarianserouslowmalignantpotentialtumors.MolCancerRes,2008,6:1678-1690.@@[13]HsuCY,BristowR,ChaMS,etal.Characterizationofactivemitogen-activatedproteinkinaseinovarianserouscarcinomas.ClinCancerRes,2004,10:6432-6436.@@[14]SingerG,St(o)hrR,CopeL,etal.Patternsofp53mutationsseparateovarianserousborderlinetumorsandlow-andhigh-gradecarcinomasandprovidesupportforanewmodelofovariancarcinogenesis:amutationalanalysiswithimmunohistochemicalcorrelation.AmJSurgPathol,2005,29:218-224.@@[15]PratJ,RibéA,GallardoA.Hereditaryovariancancer.HumPathol,2005,36:861-870.@@[16]ShawPA,RouzbahmanM,PizerES,etal.CandidateserouscancerprecursorsinfallopiantubeepitheliumofBRCA1/2mutationcarriers.ModPatho1,2009,22:1133-1138.@@[17]JarboeE,Folkin...
