Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Gynecol Oncol. 2021 Mar;160(3):735-741. doi: 10.1016/j.ygyno.2020.12.012. Epub 2020 Dec 22.
To validate the revised 2018 International Federation of Gynecologic and Obstetrics (FIGO) staging system in patients who underwent diagnostic magnetic resonance imaging (MRI) and radiotherapy (RT) for locally advanced cervix cancer.
We analyzed 677 patients who were diagnosed with pelvic MRI and treated with definitive (chemo-)RT for locally advanced cervix cancer (stage IB2/IIA2-IVA or N+) between 1992 and 2018. Patients were classified according to 2009 and 2018 FIGO staging, and survival outcomes were compared. We developed a nomogram to improve prediction of progression-free survival (PFS).
Pelvic and paraaortic lymph nodes were positive in 331 (48.9%) and 78 (11.5%) patients, respectively. At a median follow-up of 77.9 months, the 5-year PFS was 83.5%, 65.2%, 71.0%, 60.6%, 37.6% and 38.9% for IB, IIA, IIB, IIIA, IIIB and IVA according to FIGO 2009 and 88.9%, 60.0%, 73.8%, 66.7%, 36.3%, 68.9%, 43.6%, and 38.9% for IB, IIA, IIB, IIIA, IIIB, IIIC1, IIIC2, and IVA according to FIGO 2018, respectively. Survival of stage IIIC cervix cancer depended on the local extent of the tumor: the 5-year PFS of T1, T2, and T3 stages were 80.3%, 73.9%, and 45.5% for IIIC1 and 100%, 44.9%, and 23.4% for IIIC2. Histology, tumor size, node metastasis, FIGO 2009, and treatment modality were independent prognostic factors in the Cox regression analysis, and the nomogram incorporating these factors outperformed FIGO 2009 and FIGO 2018 (AUC 0.718 vs. 0.616 vs. 0.594).
FIGO 2018 revision was associated with heterogenous outcomes among stage III cervix cancer patients. Our nomogram can assist the FIGO system in predicting PFS after definitive RT.
验证在接受局部晚期宫颈癌诊断性磁共振成像（MRI）和放疗（RT）的患者中，修订后的 2018 年国际妇产科联合会（FIGO）分期系统的有效性。
我们分析了 1992 年至 2018 年间，677 名接受盆腔 MRI 诊断并接受局部晚期宫颈癌（IB2/IIA2-IVA 或 N+）根治性（放化疗）治疗的患者。患者根据 2009 年和 2018 年 FIGO 分期进行分类，并比较生存结果。我们开发了一个列线图来提高无进展生存（PFS）的预测能力。
盆腔和腹主动脉旁淋巴结阳性分别为 331 例（48.9%）和 78 例（11.5%）。中位随访 77.9 个月后，根据 FIGO 2009 分期，IB、IIA、IIB、IIIA、IIIB 和 IVA 期患者的 5 年 PFS 分别为 83.5%、65.2%、71.0%、60.6%、37.6%和 38.9%，而根据 FIGO 2018 分期，IB、IIA、IIB、IIIA、IIIB、IIIC1、IIIC2 和 IVA 期患者的 5 年 PFS 分别为 88.9%、60.0%、73.8%、66.7%、36.3%、68.9%、43.6%和 38.9%。宫颈癌 IIIC 期的生存取决于肿瘤的局部范围：T1、T2 和 T3 期 IIIC1 患者的 5 年 PFS 分别为 80.3%、73.9%和 45.5%，而 IIIC2 患者的 5 年 PFS 分别为 100%、44.9%和 23.4%。组织学、肿瘤大小、淋巴结转移、FIGO 2009 分期和治疗方式是 Cox 回归分析中的独立预后因素，包含这些因素的列线图优于 FIGO 2009 分期和 FIGO 2018 分期（AUC 0.718 与 0.616 与 0.594）。
FIGO 2018 修订版与 III 期宫颈癌患者的异质结局相关。我们的列线图可以帮助 FIGO 系统预测根治性 RT 后的无进展生存。
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