基于肿瘤学结局探讨2018年国际妇产科联盟（FIGO）宫颈癌IIIC期分期的合理性：一项队列研究
Discussion on the rationality of FIGO 2018 stage IIIC for cervical cancer with oncological outcomes: a cohort study.
作者信息
Li Zhiqiang, Duan Hui, Guo Jianxin, Yang Ying, Wang Wuliang, Hao Min, Li Weili, Li Pengfei, Bin Xiaonong, Lang Jinghe, Liu Ping, Chen Chunlin
机构信息
Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Obstetrics and Gynecology, Daping Hospital, Army Medical University, Chongqing, China.
出版信息
Ann Transl Med. 2022 Jan;10(2):122. doi: 10.21037/atm-21-6374.
BACKGROUND
This study explored the rationality of the 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IIIC for cervical cancer to determine outcomes.
METHODS
We conducted a retrospective study of cervical cancer patients who had received radical surgery or Radiotherapy. Multivariate analysis was used to compare 5-year overall survival (OS) and disease-free survival (DFS) for FIGO 2018 stages IIIA, IIIB, and IIIC cervical cancer patients. Based on tumor-node-metastasis (TNM) staging, IIIC cases were divided into 5 subgroups: T1a, T1b, T2a, T2b, and T3. The 5-year OS and DFS of the different IIIC subgroups were further compared using multivariate analysis.
RESULTS
(I) The 5-year OS for FIGO 2018 IIIA (n=251), IIIB (n=1,824), and IIIC (n=3,137) were 73.7%, 69.0%, and 74.3%, respectively (P<0.001), and DFS rates were 64.3%, 60.6%, and 68.0%, respectively (P<0.001). Multivariate analysis indicated that IIIA was associated with 5-year OS [hazard ratio (HR) =0.998, 95% confidence interval (CI): 0.739-1.349, P=0.990], but there was no significant correlation with DFS (HR =1.081, 95% CI: 0.843-1.387, P=0.539). Compared with IIIC, IIIB had a lower 5-year OS (HR =1.291, 95% CI: 1.135-1.468, P<0.001) and DFS (HR =1.354, 95% CI: 1.215-1.508, P<0.001). (II) The 5-year OS of the T1a group (n=4), T1b group (n=861), T2a group (n=587), T2b (n=641) group, and T3 group (n=1,044) were 100.0%, 81.9%, 76.1%, 74.0%, and 65.0%, respectively (P<0.001), and the 5-year DFS were 100.0%, 74.5%, 65.9%, 72.6%, and 61.3%, respectively (P<0.001). Multivariate analysis indicated that compared with the T1b group, T2a (HR =1.405, 95% CI: 1.076-1.834, P=0.012), T2b (HR =1.592, 95% CI: 1.203-2.108, P=0.001), and T3 (HR =2.495, 95% CI: 1.971-3.157, P<0.001) were associated with a lower 5-year OS. T2a (HR =1.372, 95% CI: 1.108-1.699, P=0.004), T2b (HR =1.337, 95% CI: 1.061-1.684, P=0.014), and T3 (HR =2.015, 95% CI: 1.659-2.446, P<0.001) were associated with lower 5-year DFS.
CONCLUSIONS
The outcome for FIGO 2018 stage IIIC cervical cancer is not worse than that for stage IIIB or IIIA. The outcome for stage IIIC is related to local tumor factors. As the local tumor progresses, the oncological outcome worsens.
背景
本研究探讨了2018年国际妇产科联盟（FIGO）宫颈癌IIIC期的合理性，以确定其预后情况。
方法
我们对接受了根治性手术或放疗的宫颈癌患者进行了一项回顾性研究。采用多因素分析比较2018年FIGO IIIA期、IIIB期和IIIC期宫颈癌患者的5年总生存率（OS）和无病生存率（DFS）。基于肿瘤-淋巴结-转移（TNM）分期，IIIC期病例被分为5个亚组：T1a、T1b、T2a、T2b和T3。使用多因素分析进一步比较不同IIIC亚组的5年OS和DFS。
结果
（I）2018年FIGO IIIA期（n = 251）、IIIB期（n = 1,824）和IIIC期（n = 3,137）的5年OS分别为73.7%、69.0%和74.3%（P < 0.001），DFS率分别为64.3%、60.6%和68.0%（P < 0.001）。多因素分析表明，IIIA期与5年OS相关[风险比（HR）= 0.998，95%置信区间（CI）：0.739 - 1.349，P = 0.990]，但与DFS无显著相关性（HR = 1.081，95% CI：0.843 - 1.387，P = 0.539）。与IIIC期相比，IIIB期的5年OS（HR = 1.291，95% CI：1.135 - 1.468，P < 0.001）和DFS（HR = 1.354，95% CI：1.215 - 1.508，P < 0.001）较低。（II）T1a组（n = 4）、T1b组（n = 861）、T2a组（n = 587）、T2b组（n = 641）和T3组（n = 1,044）的5年OS分别为100.0%、81.9%、76.1%、74.0%和65.0%（P < 0.001），5年DFS分别为100.0%、74.5%、65.9%、72.6%和61.3%（P < 0.001）。多因素分析表明，与T1b组相比，T2a组（HR = 1.405，95% CI：1.076 - 1.834，P = 0.012）、T2b组（HR = 1.592，95% CI：1.203 - 2.108，P = 0.001）和T3组（HR = 2.495，95% CI：1.971 - 3.157，P < 0.001）的5年OS较低。T2a组（HR = 1.372，95% CI：1.108 - 1.699，P = 0.004）、T2b组（HR = 1.337，95% CI：1.061 - 1.684，P = 0.014）和T3组（HR = 2.015，95% CI：1.659 - 2.446，P < 0.001）的5年DFS较低。
结论
2018年FIGO IIIC期宫颈癌的预后并不比IIIB期或IIIA期差。IIIC期的预后与局部肿瘤因素有关。随着局部肿瘤进展，肿瘤学预后恶化。
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