Background/Objectives: Serous ovarian carcinoma (SOC) is the most common subtype of epithelial ovarian cancer, with high-grade (HGSOC) and low-grade (LGSOC) subtypes presenting distinct clinical behaviours. This study aimed to evaluate histopathologic features in SOC, correlating these with prognostic outcomes, and explore the potential clinical implications. Methods: We analysed 51 SOC cases for lymphovascular space invasion (LVSI), tumour border configuration (TBC), microvessel density (MVD), tumour budding (TB), the tumour–stroma ratio (TSR), the stromal type, tumour-infiltrating lymphocytes (TILs), and tertiary lymphoid structures (TLSs). A validation cohort of 54 SOC cases from The Cancer Genome Atlas (TCGA) was used for comparison. Results: In the discovery set, significant predictors of aggressive behaviour included LVSI, high MVD, high TB, and low TILs. These findings were validated in the validation set where the absence of TLSs, lower peritumoural TILs, immature stromal type, and low TSR were associated with worse survival outcomes. The stromal type was identified as an independent prognostic predictor in SOC across both datasets. Inter-observer variability analysis demonstrated substantial to almost perfect agreement for these features, ensuring the reproducibility of the findings. Conclusions: The histopathological evaluation of immune and stromal features, such as TILs, TLSs, TB, TSR, and stromal type, provides critical prognostic information for SOC. Incorporating these markers into routine pathological assessments could enhance risk stratification and guide treatment, offering practical utility, particularly in low-resource settings when molecular testing is not feasible.
背景/目的：浆液性卵巢癌（SOC）是上皮性卵巢癌最常见的亚型，其中高级别（HGSOC）与低级别（LGSOC）亚型具有不同的临床行为。本研究旨在评估SOC的组织病理学特征，分析其与预后的相关性，并探讨潜在的临床意义。方法：我们对51例SOC病例进行了分析，评估指标包括淋巴血管间隙侵犯（LVSI）、肿瘤边界形态（TBC）、微血管密度（MVD）、肿瘤出芽（TB）、肿瘤-间质比（TSR）、间质类型、肿瘤浸润淋巴细胞（TILs）及三级淋巴结构（TLSs）。同时使用癌症基因组图谱（TCGA）中54例SOC病例作为验证队列进行比较。结果：在发现集中，LVSI、高MVD、高TB和低TILs是侵袭性行为的重要预测因子。这些发现在验证集中得到证实，其中TLS缺失、较低的瘤周TILs、未成熟间质类型和低TSR与较差的生存结局相关。在两个数据集中，间质类型均被确定为SOC的独立预后预测因子。观察者间变异分析显示这些特征具有高度一致性，确保了研究结果的可重复性。结论：对TILs、TLSs、TB、TSR及间质类型等免疫与间质特征的病理学评估，能为SOC提供关键的预后信息。将这些标志物纳入常规病理评估可加强风险分层并指导治疗，具有实际应用价值，尤其在资源有限、无法进行分子检测的情况下更具实用性。
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