利用 2018 年 FIGO 分期系统构建的宫颈癌新型预后列线图：一项大型多中心研究。
A novel prognostic nomogram utilizing the 2018 FIGO staging system for cervical cancer: A large multicenter study.
机构信息
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.
Department of Obstetrics and Gynecology of Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Int J Gynaecol Obstet. 2021 Oct;155(1):86-94. doi: 10.1002/ijgo.13644. Epub 2021 May 3.
OBJECTIVE
To evaluate the prognostic performance of the revised 2018 FIGO staging system for cervical cancer.
METHODS
This retrospective multicenter study enrolled cervical cancer patients with 2009 FIGO Stage IA1-IIA2 who underwent surgeries between January 2006 and December 2017 in four tertiary hospitals. Patients were restaged according to the 2018 FIGO staging system by reviewing their medical data.
RESULTS
Of 3238 cervical cancer patients included, 1841 (56.9%) patients were restaged: 641 (34.9%) due to tumor size, 544 (29.5%) due to lymph node metastasis, 614 (33.4%) due to the inconsistency between pre- and postoperative assessments, and 42 due to the cancellation of invasion width in Stage IA. After restaging, a clear tendency of decreased recurrence-free survival (RFS) and overall survival (OS) with increasing stage was observed. Multivariate Cox analysis showed that 2018 FIGO stage, parametrial involvement, and histology were independent prognostic factors for both OS and RFS (P < 0.05). Based on these factors, we established predictive nomograms with c-indexes of 0.735 and 0.721, showing good predictive ability for cervical cancer.
CONCLUSION
The revised 2018 FIGO staging system can better reflect the survival of cervical cancer patients. Based on it, we established a nomogram that can predict the prognosis of cervical cancer patients more precisely.
目的
评估修订后的 2018 年 FIGO 分期系统对宫颈癌的预后表现。
方法
本回顾性多中心研究纳入了 2009 年 FIGO 分期为 IA1-IIA2 的宫颈癌患者，这些患者在 2006 年 1 月至 2017 年 12 月期间在 4 家三级医院接受了手术。通过回顾患者的医疗数据，根据 2018 年 FIGO 分期系统对患者进行重新分期。
结果
在 3238 例宫颈癌患者中，有 1841 例（56.9%）患者被重新分期：641 例（34.9%）因肿瘤大小，544 例（29.5%）因淋巴结转移，614 例（33.4%）因术前和术后评估不一致，42 例（2.2%）因 IA 期的侵犯宽度被取消。重新分期后，观察到随着分期的增加，无复发生存率（RFS）和总生存率（OS）明显下降。多变量 Cox 分析表明，2018 年 FIGO 分期、宫旁侵犯和组织学是 OS 和 RFS 的独立预后因素（P<0.05）。基于这些因素，我们建立了预测nomogram，其 C 指数分别为 0.735 和 0.721，显示出对宫颈癌有良好的预测能力。
结论
修订后的 2018 年 FIGO 分期系统能更好地反映宫颈癌患者的生存情况。在此基础上，我们建立了一个能更准确预测宫颈癌患者预后的 nomogram。
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