修订后的 2018 年 FIGO 宫颈癌分期系统是否比之前分期为 IB 期的女性的 2009 年 FIGO 分期系统更具预后价值？

Is the revised 2018 FIGO staging system for cervical cancer more prognostic than the 2009 FIGO staging system for women previously staged as IB disease?

机构信息

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey.

Department of Gynecologic Oncology, Zekai Tahir Burak Women's Health Training and Research Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:209-214. doi: 10.1016/j.ejogrb.2019.07.002. Epub 2019 Jul 6.

DOI:10.1016/j.ejogrb.2019.07.002

PMID:31325847

Abstract

OBJECTIVE

The purpose of this study was to compare the prognostic value of the revised FIGO staging system with that of the 2009 FIGO staging system for women previously staged as IB disease.

METHODS

Institutional cervical cancer databases of two high-volume gynecologic cancer centers in Ankara, Turkey, were retrospectively analyzed. Only women with 2009 FIGO stage IB1 or IB2 disease who underwent primary surgery were included. Survival curves were generated using Kaplan-Meier plots, and the log-rank test was used for survival comparisons. The Cox proportional hazards regression model was used to obtain hazard ratios (HRs) and 95% confidence interval (CI).

RESULTS

Data from 425 women were analyzed. The 2009 FIGO stage IB2 (n = 131) disease was associated with a nearly three-fold increased risk of mortality when compared to the 2009 FIGO stage IB1 (n = 294) disease (HR: 2.72, 95% CI: 1.69-4.37; p < 0.001). Stage migration was observed in 372 (87.5%) patients, according to the revised FIGO staging system, leading to no significant difference in five-year overall survival rates between stage IB1 (n=53) and IB2 (n=127) disease (95.2% vs. 89.3%, respectively; p = 0.23),or between stage IB2 (n=127) and IB3 (n=95) disease (89.3% vs. 84.2%, respectively; p = 0.12). Similarly, there was no significant difference in five-year overall survival rates between stage IIIC1 (n=114) and IIIC2 (n=36) disease (79.0% vs. 67.2%, respectively; p = 0.34).

CONCLUSION

When compared to the 2009 FIGO staging system, the revised staging system has more sub-stages, which leads to fewer patients in each sub-stage, resulting in diminished statistical power.

摘要

目的

本研究旨在比较修订后的 FIGO 分期系统与 2009 年 FIGO 分期系统对于先前分期为 IB 疾病的女性的预后价值。

方法

回顾性分析土耳其安卡拉两家高容量妇科癌症中心的机构宫颈癌数据库。仅纳入 2009 年 FIGO 分期为 IB1 或 IB2 且接受初次手术的女性。使用 Kaplan-Meier 图生成生存曲线，并使用对数秩检验进行生存比较。使用 Cox 比例风险回归模型获得风险比（HR）和 95%置信区间（CI）。

结果

共分析了 425 名女性的数据。与 2009 年 FIGO 分期 IB1 疾病（n=294）相比，2009 年 FIGO 分期 IB2 疾病（n=131）疾病的死亡风险几乎增加了三倍（HR：2.72，95%CI：1.69-4.37；p<0.001）。根据修订后的 FIGO 分期系统，372 名（87.5%）患者发生了分期迁移，导致 IB1 期（n=53）和 IB2 期（n=127）疾病之间五年总生存率无显著差异（分别为 95.2%和 89.3%；p=0.23），或 IB2 期（n=127）和 IB3 期（n=95）疾病之间五年总生存率无显著差异（分别为 89.3%和 84.2%；p=0.12）。同样，IIIC1 期（n=114）和 IIIC2 期（n=36）疾病之间五年总生存率也无显著差异（分别为 79.0%和 67.2%；p=0.34）。