FIGO 2018 宫颈癌分期标准：对分期迁移和生存的影响。
FIGO 2018 staging criteria for cervical cancer: Impact on stage migration and survival.
机构信息
Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, United States of America; Department of Radiation Oncology, Washington University in St. Louis School of Medicine, United States of America; Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, United States of America; Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, United States of America.
Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, United States of America.
出版信息
Gynecol Oncol. 2020 Jun;157(3):639-643. doi: 10.1016/j.ygyno.2020.03.027. Epub 2020 Apr 2.
OBJECTIVE
To compare FIGO 2009 and FIGO 2018 cervical cancer staging criteria with a focus on stage migration and treatment outcomes.
METHODS
This study is based on a database cohort of 1282 patients newly diagnosed with cervical cancer from 1997 to 2019. All underwent standard clinical examination and whole-body FDG-PET. Tumor stage was recorded using the FIGO 2009 system, which excluded surgical pathologic, FDG-PET and other advanced imaging findings, and then re-classified to the FIGO 2018 system, including surgical pathologic and imaging findings. Patient management was based on clinical, surgical, and imaging findings. Stage migration and prognosis were evaluated.
RESULTS
The distribution per the 2009 staging system was stage I in 593 (46%), stage II in 342 (27%), stage III in 263 (21%), and stage IV in 84 (7%) and the 2018 staging system was stage I in 354 (28%), stage II in 156 (12%), stage III in 601 (47%), and stage IV in 171 (13%). No patients were down-staged. Stage migration occurred in 53% (676/1282) and was attributable to detection of occult lymph node metastasis in 520 (41%), occult distant metastasis in 90 (7%), and tumor size and extent in 66 (5%). The 5-year progression-free survivals (PFS) by FIGO 2009 versus FIGO 2018 were as follows: stage I, 80% vs. 87% (p = 0.02); stage II, 59% vs. 71% (p = 0.002); stage III, 35% vs. 55% (p < 0.001), and stage IV, 20% vs. 16% (p = 0.41).
CONCLUSION
Inclusion of surgical pathologic and imaging findings resulted in upward stage migration in the majority, mostly related to nodal and distant metastasis. While FIGO 2018 improves survival discriminatory ability for stages I and IV patients, survival remains heterogeneous among stage III substages.
目的
比较 FIGO 2009 与 FIGO 2018 宫颈癌分期标准，重点关注分期迁移和治疗结果。
方法
本研究基于 1997 年至 2019 年期间新诊断为宫颈癌的 1282 例患者的数据库队列。所有患者均接受标准临床检查和全身 FDG-PET。肿瘤分期采用 FIGO 2009 系统记录，该系统排除了手术病理、FDG-PET 和其他先进影像学发现，然后重新分类为 FIGO 2018 系统，包括手术病理和影像学发现。患者管理基于临床、手术和影像学发现。评估分期迁移和预后。
结果
根据 2009 年分期系统，分布为 I 期 593 例（46%）、II 期 342 例（27%）、III 期 263 例（21%）和 IV 期 84 例（7%），2018 年分期系统为 I 期 354 例（28%）、II 期 156 例（12%）、III 期 601 例（47%）和 IV 期 171 例（13%）。没有患者降期。53%（676/1282）发生分期迁移，归因于 520 例（41%）隐匿性淋巴结转移、90 例（7%）隐匿性远处转移和 66 例（5%）肿瘤大小和范围。FIGO 2009 与 FIGO 2018 的 5 年无进展生存率（PFS）如下：I 期，80%比 87%（p=0.02）；II 期，59%比 71%（p=0.002）；III 期，35%比 55%（p<0.001），IV 期，20%比 16%（p=0.41）。
结论
纳入手术病理和影像学发现导致大多数患者向上分期迁移，主要与淋巴结和远处转移有关。虽然 FIGO 2018 提高了 I 期和 IV 期患者的生存区分能力，但 III 期亚分期的生存仍存在异质性。
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