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

 

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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.

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