Ten Eikelder Mieke L G, Hinten Floor, Smits Anke, Van der Aa Maaike A, Bekkers Ruud L M, IntHout Joanna, Wenzel Hans H B, Zusterzeel Petra L M
Department of Gynecological Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organization, 3501 DB Utrecht, The Netherlands.
Cancers (Basel). 2022 Jun 27;14(13):3140. doi: 10.3390/cancers14133140.
The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007-2017. Kaplan-Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan.
国际妇产科联盟（FIGO）2018年分期系统的引入是为了更好地对宫颈癌进行预后区分，这导致了相当程度的分期迁移并影响了治疗方案。我们评估了FIGO 2018年分期在预测临床早期宫颈癌无复发生存期（RFS）和总生存期（OS）方面的准确性，并与FIGO 2009年分期进行比较。我们开展了一项全国性回顾性队列研究，纳入了2007年至2017年间术前FIGO（2009）IA1、IA2和IB1期宫颈癌患者2264例。采用Kaplan-Meier分析评估生存结局。采用逻辑回归分析评估淋巴结转移和宫旁浸润的危险因素。分期迁移发生率为48%（22%分期降低，26%分期升高）。从IB期降为IA1/2期患者的生存数据与FIGO 2009年IA1/2期患者相当，且优于仍为IB1期的患者。淋巴血管间隙浸润（LVSI）、浸润深度和宫旁浸润是淋巴结转移的危险因素。LVSI、分级和年龄与宫旁浸润相关。总之，FIGO 2018年分期系统准确反映了早期宫颈癌的预后，因此比FIGO 2009年分期更合适。然而，基于有无LVSI而非浸润深度对IA1或IA2期进行细分会提高准确性。对于降为IA1/2期的患者，似乎采用不太激进的手术是合适的，不过在确定治疗方案时应考虑LVSI和组织学情况。
