Proposal of Novel Binary Grading Systems for Cervical Squamous Cell Carcinoma

Area of Science:

• Oncology
• Pathology
• Cancer Research

Background:

• Cervical squamous cell carcinoma (CSCC) grading systems are crucial for prognosis.
• Existing systems like Broders, Jesinghaus, and Silva patterns have limitations in reproducibility and predictive accuracy.
• Tumor stroma interactions are increasingly recognized as important prognostic factors.

Purpose of the Study:

• To compare existing grading systems for CSCC.
• To examine associations between tumor grade, tumor stroma, and patient outcomes (overall survival [OS], progression-free survival [PFS]).
• To develop and validate novel binary grading systems incorporating tumor stromal features.

Main Methods:

• Retrospective analysis of 670 CSCC tumor slides from 10 international institutions.
• Evaluation of Broders tumor grade, Jesinghaus grade, Silva pattern, and tumor stroma.
• Development of binary grading systems by integrating stromal changes into Broders and Jesinghaus systems.
• Statistical analysis of associations with OS, PFS, and lymph node metastases.

Main Results:

• Poor inter-observer reproducibility was observed among existing grading systems (κ values as low as 0.215).
• Existing grading systems demonstrated limited predictive accuracy for OS and PFS.
• The developed binary grading systems showed improved predictive accuracy for OS and PFS.
• Both Jesinghaus tumor grade and the proposed binary systems were significantly associated with lymph node metastases.

Conclusions:

• Histologic grading in CSCC is characterized by poor reproducibility and limited prognostic value.
• The novel binary grading systems incorporating tumor stromal characteristics offer enhanced predictive accuracy for patient survival.
• These improved grading systems can better predict the presence of lymph node metastases, aiding in treatment decisions.