Survival Analysis Of Revised 2013 FIGO Staging Classification Of Epithelial Ovarian Cancer And Comparison With Previous FIGO Staging Classification : Based On 406 Cases

Objective:Epithelial ovarian carcinoma is a disease with high recurrence rate and low survival rate,Especially in advance stage.The purpose of this paper is to analyze the prognostic role of revised version of International of Gynecology and Obstetrics(FIGO)stage(2013)in epithelial ovarian cancer and compare with previous version staging classification.Methods:We retrospectively enrolled patients with epithelial ovarian cancer treated at the First Affiliated Hospital of Dalian medical university from February 2002 to March 2014.We reclassified the patients based on the revised FIGO staging classification.All patients followed up until November 2015.Then compare the lifetime between substage of old version and new version by univariate and multivariate analysis and analyze any factor of sub-stage which impact on prognosis.Results:The main change for new version: Four hundred and six patients were enrolled(stage I,23.4%;stage II,13.5%;stage III,59.9%;stage IV,3.2%).Previous stage IC(60,14.8%)was subdivided into IC1(15,3.7%),IC2(29,7.1%),and IC3(16,3.9%).Also,IIC has been eliminated and integrated into IIA(23,5.7%)and IIB(32,7.9%).Number of patients with stage IIIC in previous staging system(208,51.2%)decreased in new staging system(195,48%).Relatively,combined number of patients with stage IIIA1(i)(4,1.0%),IIIA1(ii)(4,1.0%),IIIA2(7,1.7%),IIIB(33,8.1%)was increased in new staging system.In addition,previous stage IV(13,3.2%)was categorized into IVA(6,1.5%)and IVB(7,1.7%)in new staging classification.1.Stage I: Revised FIGO stage I had significant prognostic impact on PFS(P=0.028),but not on old version staging classification(P=0.068).In terms of OS,either previous or revised FIGO stages did not show statistical significance on prognosis.When we performed multivariate analysis by COX model,none of the survival analyses approved prognostic role of either FIGO sub-stage classifications in terms of PFS and OS in stage I.The median progression-free survival time of stage I in new version is: IA 137 months,IB 104 months,IC1 103 months,IC2 81 months,IC3 108 months,the whole median progression-free survival time in stage I is 118 months.2.Stage II: In univariate analysis,either previous or revised FIGO stage II did not show statistical significance in terms of PFS and OS.While,when we performed multivariate analysis to adjust age,cell type,grade,and surgical outcomes,revised FIGO stage IIB had significance prognostic impact on PFS(HR,4.40;P=0.021;95%CI 1.25-15.53),but not on old version(HR,3.69;P=0.281;95%CI 0.477-12.846).In terms of OS,although any sub-stage in new version did not show statistical significance.It also indicate better impact on prognosis(HR,2.74;P=0.076;95% CI 0.898-8.384).The median progression-free survival time of sub-stage in new version is : IIA 70 months,IIB 113 months,the whole median survival time in stage II is 103 months.3.Stage III: In univariate analysis,None of the survival analyses approved prognostic role of either FIGO stage classcification in terms of PFS and OS in stage III.The sub-stage in new version appears the trend of descending approximately in median survival time,which may be more advantage in directing prognosis.In multivariate analysis,sub-stage in new version was not significant prognostic role.The median progression-free survival time of sub-stage in new version is : IIIA1(i)38months,IIIA1(ii)12months,IIIA2 51 months,IIIB 49 months,IIIC 38 months,the whole median progression-free survival time in stage III is 41 months.4.Stage IV: We could not find any statistical significant survival differences in PFS(P=0.48)and OS(P=0.979)and these non-significant findings still remained in multivariate analysis as well.The median progression-free survival time of sub-stage in new version is : IVA 12 months,IVB 13 months,the whole median progression-free survival time in stage IV is 14 months.Conclusion:Revised FIGO stage has more progressed utility for informing prognosis than previous version,especially in stage I and II.For stage III and IV,further validation should be needed in large population based study in the future.