Rosendahl Mikkel, Høgdall Claus Kim, Mosgaard Berit Jul
Department of Gynecology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Int J Gynecol Cancer. 2016 May;26(4):680-7. doi: 10.1097/IGC.0000000000000675.
With the 2013 International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube, and primary peritoneal cancer, the number of substages changed from 10 to 14. Any classification of a malignancy should easily assign patients to prognostic groups, refer patients to individualized treatments, and allow benchmarking and comparison of patients and results between centers. The stage should reflect survival in particular. The objective of the study was to validate these requirements of the revised FIGO staging on a high number of ovarian cancer patients.
Demographic, surgical, histological, and survival data from 4036 ovarian cancer patients were used in the analysis. Five-year survival rates (5YSR) and hazard ratios for the old and revised FIGO staging were calculated using Kaplan-Meier curves and Cox regression.
A total of 1532 patients were assigned to new stages. Stages IA and IC1 had similar survival (5YSR, 87%); and stages IB, IC2, and IC3 had similar survival (5YSR, 75%-80%). Stage IIC was omitted, resulting in similar survival in stages IIA and IIB (5YSR, 61% and 65%). Of 1660 patients in stage IIIC, 79 were restaged: In 16 cases, IIIC was down-staged to IIIA1, as they had only been stage IIIC owing to lymph node metastases; and in 63 cases, IIIC was down-staged to IIIB, as they had lymph node metastases and abdominal tumor of less than 2 cm. The 5YSR in stage IIIC was unchanged (22%). Stage IV (5YSR, 14% ) was restaged as IVA (13%) and IVB (13%). Both were different from IIIC; P < 0.0001.
With introduction of new substages, staging becomes more demanding. Second, as fewer patients are allocated to each substage, statistical power is diminished, resulting in uncertainty in the results. Despite this, and most importantly, the revised coding adequately reflects survival, as there was a clear graphical and statistical tendency for poorer survival with increasing stage.
随着2013年国际妇产科联盟（FIGO）对卵巢癌、输卵管癌和原发性腹膜癌的分期，亚分期数量从10个增加到14个。任何恶性肿瘤的分类都应能轻松地将患者归入预后组，为患者提供个体化治疗，并便于各中心之间对患者及结果进行基准对比。分期尤其应反映生存率。本研究的目的是在大量卵巢癌患者中验证FIGO修订分期的这些要求。
分析采用了4036例卵巢癌患者的人口统计学、手术、组织学和生存数据。使用Kaplan-Meier曲线和Cox回归计算旧版和修订版FIGO分期的五年生存率（5YSR）和风险比。
共有1532例患者被归入新分期。IA期和IC1期生存率相似（5YSR，87%）；IB期、IC2期和IC3期生存率相似（5YSR，75%-80%）。IIC期被省略，导致IIA期和IIB期生存率相似（5YSR，分别为61%和65%）。在1660例IIIC期患者中，79例重新分期：16例中，IIIC期降为IIIA1期，因为他们仅因淋巴结转移而处于IIIC期；63例中，IIIC期降为IIIB期，因为他们有淋巴结转移且腹部肿瘤小于2 cm。IIIC期的5YSR未变（22%）。IV期（5YSR，14%）重新分期为IVA期（13%）和IVB期（13%）。两者均与IIIC期不同；P<0.0001。
随着新亚分期的引入，分期要求更高。其次，由于每个亚分期分配的患者减少，统计效能降低，导致结果存在不确定性。尽管如此，最重要的是，修订后的编码充分反映了生存率，因为随着分期增加生存率降低有明显的图表和统计学趋势。
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