Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA.
Int J Gynecol Cancer. 2012 Mar;22(3):452-6. doi: 10.1097/IGC.0b013e31823de6dd.
Our aim was to evaluate the prognostic significance of the revised 2009 International Federation of Gynecology and Obstetrics (FIGO) staging criteria in patients with uterine serous carcinoma (USC).
We retrieved clinical and histopathologic data on women with USC from 2 large academic centers. Age, race, stage, myometrial invasion, angiolymphatic invasion, and adjuvant therapy were analyzed using Kaplan-Meier and Cox regression models.
A total of 168 patients were included. Three-year survival rate was 81% for revised stage I, 52% for stage II, 46% for stage III, and 19% for stage IV. Survival was not significantly different when comparing overall 1988 FIGO stage I or II to 2009 FIGO stage I or II. The 3-year survival rate for 1988 stage IA (93%), IB (75%), and IC (60%) significantly differed (P = 0.02). When patients were restaged using the 2009 staging system, the 3-year overall survival of 2009 stage IA dropped to 83.4% and 68.8% for stage IB. New FIGO stage, myometrial invasion, angiolymphatic invasion, and administration of chemotherapy all remained independent predictors of survival on multivariate analysis (P < 0.05). Of note, extrauterine disease was observed in 22% of patients without myometrial invasion. Age and race were not prognostic factors for either classification.
The streamlined 2009 FIGO criteria do not adequately delineate survival for USC in early-stage disease. The 1988 FIGO classification correctly identified 3 subgroups of stage I USC patients with significantly different survival that is lost with the elimination of the most favorable 1988 stage IA subgroup. Because evaluation for adjuvant therapy and patient planning may change based on survival information, further evaluation of more appropriate USC staging is warranted. Caution should be taken when evaluating therapeutic response and comparing studies using these revised criteria in the future.
本研究旨在评估修订后的 2009 年国际妇产科联合会（FIGO）分期标准在子宫浆液性癌（USC）患者中的预后意义。
我们从 2 个大型学术中心检索了 USC 患者的临床和组织病理学数据。采用 Kaplan-Meier 和 Cox 回归模型分析患者的年龄、种族、分期、肌层浸润、血管淋巴管浸润和辅助治疗情况。
共纳入 168 例患者。修订后的Ⅰ期患者 3 年生存率为 81%，Ⅱ期为 52%，Ⅲ期为 46%，Ⅳ期为 19%。比较 1988 年 FIGO Ⅰ期或Ⅱ期与 2009 年 FIGO Ⅰ期或Ⅱ期，整体生存率无显著差异。1988 年ⅠA 期（93%）、ⅠB 期（75%）和ⅠC 期（60%）的 3 年生存率差异有统计学意义（P=0.02）。当患者使用 2009 年分期系统重新分期时，2009 年ⅠA 期患者的 3 年总生存率降至 83.4%，ⅠB 期降至 68.8%。新的 FIGO 分期、肌层浸润、血管淋巴管浸润和化疗的应用均为多因素分析中的独立预后因素（P<0.05）。值得注意的是，无肌层浸润的患者中有 22%存在宫外疾病。年龄和种族均不是两种分类的预后因素。
简化的 2009 年 FIGO 标准不能充分区分 USC 早期疾病的生存情况。1988 年 FIGO 分类正确识别了 3 个具有显著不同生存率的Ⅰ期 USC 患者亚组，而消除了最有利的 1988 年ⅠA 亚组则导致这种生存率的丧失。由于辅助治疗的评估和患者计划可能会根据生存信息而改变，因此有必要对更合适的 USC 分期进行进一步评估。在未来使用这些修订标准评估治疗反应和比较研究时应谨慎。
