修订后的国际妇产科联合会子宫内膜癌分期系统是否导致患者结局的歧视增加？
Does the revised International Federation of Gynecology and Obstetrics staging system for endometrial cancer lead to increased discrimination in patient outcomes?
机构信息
Department of Radiation Oncology, University of Utah Huntsman Cancer Hospital, Salt Lake City, Utah 84112, USA.
出版信息
Cancer. 2011 Sep 15;117(18):4231-7. doi: 10.1002/cncr.26030. Epub 2011 Mar 8.
BACKGROUND
Recent changes were made to the International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer. The objective of this study was to compare survival outcomes for patients who were staged according to the 1988 FIGO staging system versus the 2009 FIGO staging system.
METHODS
Data were obtained from the Surveillance, Epidemiology, and End Results Program for the years 1998 to 2006. Patients who had a diagnosis of adenocarcinoma of the uterus with complete staging information were included. Patients were staged according to the 1988 and 2009 FIGO staging systems, and Kaplan-Meier estimates were derived for cause-specific survival (CSS). Univariate and multivariate analyses using Cox proportional hazards models were used to identify the factors associated with survival.
RESULTS
In total, 47,284 patients were included. The median follow-up was 37 months. The 5-year CSS rates for patients who had 2009 FIGO stage IA and IB disease were 96.6% and 89.9%, respectively (P < .0001). After accounting for age, grade, and race, this survival difference remained significant (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.74-2.24; P < .0001). Patients who had 1988 FIGO stage IIA disease had a 5-year CSS rate similar to that of patients who had 1988 FIGO stage IC disease (88.6% vs 89.9%, respectively; P = .09). Patients who had positive pelvic washings had a 5-year CSS rate similar to that of patients who had stage IIIA disease according to the 2009 FIGO system (74.2% vs 72.1%, respectively; P = .37). The 5-year CSS rate for patients who had stage IIIC1 disease was significantly improved compared with that for patients who had stage IIIC2 disease (68.2% vs 57.3%, respectively; P < .0001). In the multivariate model, the survival difference remained (HR, 1.49; 95% CI, 1.26-1.76; P < .0001).
CONCLUSIONS
The 2009 staging system for endometrial cancer produced better discrimination in CSS outcomes compared with the 1988 system.
背景
最近国际妇产科联盟（FIGO）对子宫内膜癌分期系统进行了修改。本研究的目的是比较根据 1988 年 FIGO 分期系统和 2009 年 FIGO 分期系统分期的患者的生存结局。
方法
数据来自 1998 年至 2006 年的监测、流行病学和最终结果计划。纳入了具有完整分期信息的子宫腺癌诊断患者。患者根据 1988 年和 2009 年 FIGO 分期系统进行分期，并得出特定原因的生存（CSS）的 Kaplan-Meier 估计值。使用 Cox 比例风险模型进行单变量和多变量分析，以确定与生存相关的因素。
结果
共有 47284 例患者入选。中位随访时间为 37 个月。2009 年 FIGO 分期 IA 和 IB 期患者的 5 年 CSS 率分别为 96.6%和 89.9%（P<0.0001）。在考虑年龄、分级和种族后，这种生存差异仍然显著（风险比[HR]，1.97；95%置信区间[CI]，1.74-2.24；P<0.0001）。1988 年 FIGO 分期 IIA 期患者的 5 年 CSS 率与 1988 年 FIGO 分期 IC 期患者相似（分别为 88.6%和 89.9%；P=0.09）。盆腔冲洗阳性的患者 5 年 CSS 率与 2009 年 FIGO 系统的 IIIA 期患者相似（分别为 74.2%和 72.1%；P=0.37）。与 1988 年 FIGO 分期 IIIC2 期患者相比，2009 年 FIGO 分期 IIIC1 期患者的 5 年 CSS 率显著提高（分别为 68.2%和 57.3%；P<0.0001）。在多变量模型中，生存差异仍然存在（HR，1.49；95%CI，1.26-1.76；P<0.0001）。
结论
与 1988 年系统相比，2009 年子宫内膜癌分期系统在 CSS 结果方面具有更好的区分度。
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