Department of Pathology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139, Targu Mures, Romania.
Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada.
J Cancer Res Clin Oncol. 2022 Mar;148(3):577-586. doi: 10.1007/s00432-021-03850-w. Epub 2021 Nov 12.
The 2018 International Federation of Gynecology and Obstetrics (FIGO) update on cervical cancer staging eliminated horizontal tumor extent (HZTE) as a staging parameter in stage IA (microscopic) disease. We aimed to determine whether HZTE correlates with outcomes in early stage ECAs and FIGO should reinstate HZTE as a staging parameter in futures updates.
We retrospectively analyzed 416 FIGO 2009 stage I ECAs from 17 institutions and re-assigned stage using FIGO 2018. Correlation between HZTE, overall (OS) and recurrence free survival (RFS) was performed using univariable and multivariable analyses.
Re-staging 416 cases resulted in 126 (30.3%) IA and 290 (69.7%) IB cases; 85 (67.5%) IA tumors had HZTE ≤ 7 mm, while 41 (32.5%) were > 7 mm; 32 (11%) IB tumors had HZTE ≤ 7 mm, while 258 (89%) were > 7 mm (p = 0.0001). Four (3.2%) IA (1 IA1, 3 IA2) patients developed recurrence (3 ≤ 7 mm, 1 > 7 mm) compared to 41 (14.1%) IB patients (p = 0.002). Fourteen IB and no IA patients died of disease (8 IB1, 1 ≤ 7 mm). Cox univariate analysis demonstrated that only RFS is significantly influenced by HZTE (p = 0.01), while OS and RFS were not influenced by HZTE on multivariate analysis.
HZTE has limited prognostic value in early stage ECAs and is only associated with RFS on univariate but not multivariate analysis. HZTE does not improve prognostication of patients with stage I ECAs as per 2018 FIGO staging. Consequently, the rationale to remove this variable from FIGO staging is justified for ECAs.
2018 年国际妇产科联合会（FIGO）更新了宫颈癌分期，将水平肿瘤范围（HZTE）从 IA 期（显微镜下）疾病的分期参数中删除。我们旨在确定 HZTE 是否与早期宫颈癌的结局相关，FIGO 是否应该在未来的更新中重新将 HZTE 作为分期参数。
我们回顾性分析了来自 17 个机构的 416 例 FIGO 2009 期 IA 宫颈癌病例，并使用 FIGO 2018 重新分期。使用单变量和多变量分析评估 HZTE 与总生存期（OS）和无复发生存期（RFS）之间的相关性。
重新分期 416 例后，IA 期 126 例（30.3%），IB 期 290 例（69.7%）；85 例（67.5%）IA 肿瘤的 HZTE≤7mm，41 例（32.5%）>7mm；32 例（11%）IB 肿瘤的 HZTE≤7mm，258 例（89%）>7mm（p=0.0001）。4 例（3.2%）IA 期（1 例 IA1，3 例 IA2）患者出现复发（3≤7mm，1>7mm），而 41 例（14.1%）IB 期患者出现复发（p=0.002）。14 例 IB 期和 1 例 IA 期患者死于疾病（8 例 IB1，1 例≤7mm）。Cox 单变量分析表明，只有 RFS 受到 HZTE 的显著影响（p=0.01），而 OS 和 RFS 不受 HZTE 的多变量分析影响。
HZTE 在早期宫颈癌中预后价值有限，仅在单变量分析中与 RFS 相关，而在多变量分析中则不相关。根据 2018 年 FIGO 分期，HZTE 不能改善 IA 期宫颈癌患者的预后。因此，将该变量从 FIGO 分期中删除是合理的。
