| BackgroundCervical cancer(CC)is one of the most common malignancies of the female reproductive system and a leading cause of cancer deaths in women.According to the World Health Organisation(WHO)in 2018,the incidence of cervical cancer worldwide is about 13 cases per 100,000 people and the mortality rate is about 7 cases per 100,000 people.There were 569,847 new cases of cervical cancer worldwide in 2018,with a total of 31,365 deaths,of which 84%occurred in economically underdeveloped countries.Global cancer data in 2018 shows that among female malignancies,cervical cancer ranks fourth in incidence(6.6%)and fourth in mortality(7.5%),and it is more common in low-and middle-income countries(LMICs),ranking second in incidence and third in mortality.Furthermore,the global data indicates that the average age of onset of new cervical cancer has decreased,showing a younger trend.China is still a developing country and one of the major countries of cervical cancer.According to statistics,the annual number of new cases of cervical cancer accounts for 19%of the world's total.Human papillomavirus(HPV)plays the most important role in the occurrence and development of cervical cancer.Cervical cancer has a clear cause and is the only cancer that can be prevented or even cured.It can be detected or prevented early to a large extent through regular physical examination,screening and HPV vaccination.In most cases,early cervical cancer is treated surgically,including conization of cervix,radical trachelectomy,simple hysterectomy,and radical hysterectomy.Advanced cervical cancer is often treated with chemoradiotherapy or palliative care.In recent years,the biological immunotherapy of cervical cancer has become the focus,and numerous experts and scholars are exploring and practicing.Nowadays,there is an increasing emphasis on primary prevention of cervical cancer,namely HPV vaccination.The HPV vaccine,also known as the cervical cancer vaccine,is both prophylactic and therapeutic,although in clinical practice there have been relatively few reports of the use of the therapeutic HPV vaccine,which it is widely used in many countries.Prophylactic HPV vaccines are divided into bivalent(prophylactic HPV16,18),tetravalent(prophylactic HPV6,11,16,18,31,33,45,52,58)and nine-valent(prophylactic HPV6,11,16,18,31,33,45,52,58).All the relevant monitoring results show that the HPV vaccine is safe,and to a certain extent can effectively prevent HPV infection,but after inoculating the HPV vaccine,people should still pay attention to regular screening.In recent decades,the morbidity and mortality of cervical cancer have been on the decline worldwide,which is closely related to the improvement of people's health awareness,the vaccination of HPV vaccine and the improvement of cervical cancer screening system.Each malignancy has its own staging criteria for the severity of the disease.In gynecological malignancy,for instance,endometrial cancer and ovarian cancer are using the operation pathology stage,but cervical cancer is unique,it is used the clinical stage all the time.Clinical staging of cervical cancer refers to the determination of staging according to the results of gynecological pelvic triad examination before treatment.Clinical staging should be jointly determined by 2 gynecological oncologists at or above the sub-senior level,and should not be changed due to any findings once the stage is determined.As a result,the stage of cervical cancer has a large subjective factor,clinical diagnosis and treatment process is also inconvenient,the prognosis of the patient evaluation is not accurate.Although the clinical doctors also diagnose cervical cancer by computed tomography(CT),magnetic resonance imaging(MRI),positron emission tomography(PET),positron emission tomography/X-ray computed tomography imaging(PET-CT),and other auxiliary examination,the results of these imaging examination are not involved in staging.A good staging system should have the following characteristics:effective,reliable,practical.The staging of cervical Cancer was first proposed in 1929,the International Federation of Gynecology and Obstetrics(FIGO),the American Joint Commission on Cancer(AJCC),and the International Union for Cancer Control(UICC)jointly develop the staging standards.The first versions of cervical cancer staging were in the exploratory stage and were not widely accepted.In 1961,FIGO officially published the first clinical staging of cervical cancer(based on clinical pelvic trigeminal examination).Then,through clinical practice and review,experts and scholars explore continuously,cervical cancer staging has been modified many times.The FIGO cervical cancer staging has been widely used and is used from 2009 to October 2018,when the international federation of obstetricians and gynecologists revised the cervical cancer staging and made major adjustments,which is of great significance for guiding clinical practice.Since the release of the new FIGO cervical cancer staging system has caused a great response in the field of gynecology and the related departments of cervical cancer management.While praising the benefits it brings to clinical work,there are also some doubts.The application time of the new cervical cancer staging system is relatively short,and there are not many reports on the evaluation and verification of the new cervical cancer staging system through large sample data.The advantages and disadvantages of the new cervical cancer staging system need to be confirmed by more centers and large sample studies,so as to better guide the clinical work.ObjectiveThis study collected the clinical datas of 1080 patients with cervical cancer from the first afiliated hospital of zhengzhou university from July 2012 to July 2016,these datas were retrospectively analyzed,to preliminarily explore the significance of the modification of each subphase of the new FIGO cervical cancer staging system in evaluating the prognosis of patients in 2018,so as to provide certain reference for the clinical diagnosis and treatment of cervical cancer.Materials and MethodsThe clinical datas of 1080 patients of cervical cancer were collected from the first affiliated hospital of zhengzhou university from July 2012 to July 2016,these datas are including name,hospital number,age,gender,hospitalized time,date of diagnosis,operation time,name of surgical and pathological results,etc.The original clinical staging was based on the staging criteria of the 2009 FIGO cervical cancer staging system,the revised staging was based on the 2018 FIGO cervical cancer staging system.The pathological types were squamous cell carcinoma,adenocarcinoma and adenosquamous cell carcinoma.The follow-up deadline is October 2019.The clinical datas and follow-up datas were retrospectively analyzed to preliminarily explore the significance of the new FIGO cervical cancer staging system in evaluating the prognosis of patients.Results1.The ages of 1080 patients ranged from 22 to 81 years old,with an overall average age of 47.59±0.30 years.The follow-up time was 4-87 months,and the overall median follow-up time was 53 months.There were 26 cases lost to follow-up,and the follow-up rate was 97.59%.The pathological types of all patients were 949 cases(87.87%)of squamous cell carcinoma,112 cases(10.37%)of adenocarcinoma and 19 cases(1.76%)of adenosquamous cell carcinoma.Degree of differentiation:175 patients(16.20%)were poorly differentiated,736 patients(68.15%)were moderately differentiated,94 patients(8.70%)were highly differentiated,and 75 patients(6.95%)were unknown.According to the criteria of the 2009 FIGO cervical cancer staging,the stage of newly diagnosed patients was determined,and the results were as follows:70 cases(6.48%)of stage IA1,26 cases(2.41%)of stage IA2,423 cases(39.16%)of stage IB1,154 cases(14.26%)of stage IB2,151 cases(13.98%)of stage IIA1,123 cases(11.39%)of stage IIA2,111 cases(10.28%)of stage ?B,8 cases(0.74%)of stage ?A,8 cases(0.74%)of stage IIIB,6 cases(0.56%)of stage ?.Overall survival outcome:955 cases(88.42%)survived,99 cases(9.17%)died(109 cases with recurrence or metastasis),and 26 cases(2.41%)were unknown.2.In 1080 patients of cervical cancer,compared to the 2009 FIGO cervical cancer staging,a total of 397 patients(36.76%)had stage changes:among the stage IA2 patients,1 case(0.09%)to stage ?C1 due to positive pelvic lymph nodes;among the stage IB1 patients,102 cases(9.44%)were promoted to stage ?B2,12 cases(1.11%)to stage IB3,39 cases(3.61%)to stage ?C1 due to positive pelvic lymph nodes,and 4 cases(0.37%)to stage IIIC2 due to positive para-aortic lymph nodes;among the patients with IB2 stage,128 cases(11.85%)were upgraded to stage IB3,24 cases(2.22%)to stage ?C1,and 2 cases(0.18%)to stage ?C2;among the stage ?A1 patients,27 cases(2.50%)were upgraded to stage ?C1;among the stage ?A2 patients,31 cases(2.87%)were upgraded to stage ?C1:among the stage ?B patients,22 cases(2.04%)were upgraded to stage ?C1;among the stage ?A patients,2 cases(0.18%)were upgraded to stage ?C1;among the stage ?B patients,2 cases(0.18%)was upgraded to stage ?C1,1 case(0.09%)was upgraded to stage ?C2;there was no change in stage ?.3.Compared the old and new stages,the coincidence rate of stage ?A patients was 98.96%,higher than the other stages;the coincidence rate of stage ?B1 patients was 62.88%,and that of stage ?B2 patients was 66.23%;the coincidence rate of stage ?A1 patients was 82.12%and stage ?A2 patients was 74.80%;the coincidence rate of patients with stage ?B was 80.18%;the coincidence rate of stage ?A patients was 75.00%and stage IIIB patients was 62.50%.4.There were 508 patients(47.04%)in the phase IB group of the new FIGO cervical cancer staging system,of which 266 patients(52.36%)were with phase?B1,102 patients(20.08%)were with phase IB2,and 140 patients(27.56%)were with phase ?B3.A total of 29 cases(5.71%)died,with a median follow-up of 54(10-87)months.All the patients in this group received surgical treatment,including 83 cases(16.34%)of postoperative adjuvant radiotherapy,81 cases(15.94%)of adjuvant chemotherapy,259 cases(50.98%)of adjuvant chemoradiotherapy,and 19 cases(3.74%)were unknown.The results of univariate analysis showed that the overall survival rate of patients in the ?B1,IB2 and IB3 groups was 86.61%,82.07%and 78.29%,respectively.The survival rate of patients in the IB2 group was lower than that in the ?B1 group(x2=8.471,P=0.004),and the survival difference between the three substages was statistically significant(x2=3 7.494,P<0.001).The results of multi-factor analysis showed that the risk of death increased by 4.446 times for each additional stage of FIGO stage.The risk of death was 3.404 times higher in lvsi-positive patients than in lvsi-negative patients.5.There were 155 patients(14.35%)in the stage ?C group of the new FIGO cervical cancer staging system.Among them,148 patients(95.48%)had stage?C1 and 7 patients(4.52%)had stage ?C2.Imaging diagnosis was performed in 4 patients(2.58%)(3 patients with ?Clr and 1 patient with ?C2r).A total of 39 cases(25.16%)died,with a median follow-up of 47(4-84)months.The results of univariate analysis showed that the cumulative survival rate of the?C1 group decreased with the increase of the diameter of the cancer(x2=67.781,P<0.001);the overall survival rate of patients with number of lymph node metastasis ?2 and>2 was 77.52%and 50.45%,respectively,with the latter having a worse prognosis(?2=43.472,P<0.001);the overall survival rates of stage ?C1 and stage IIIC2 patients were 70.03%and 43.71%,respectively,patients with stage IIIC2 have poor prognosis(?2=4.668,P=0.031).The results of multi-factor analysis showed that the mortality risk of patients with stage ?C2 was 3.783 times that of patients with stage ?C1;the mortality risk of patients increased by 5.107 times for each stage of increase in diameter.The results of multi-factor analy sis showed that the mortality risk of patients whose lymph node metastasis were>2 was 9.529 times higher than that of patients whose lymph node metastasis were ?2.The risk of death increased by 3.795 times for each increasing in the diameter of the tumor.However,the risk of death decreased with the degree of differentiation.Conclusion1.The new FIGO cervical cancer staging system subdivides stage ?B into three sub-stages,which is more conducive to reflect the clinical characteristics and survival differences of different patients,and can better guide clinical diagnosis and treatment and evaluate the prognosis of patients.2.The newly added ?C phase in the new FIGO cervical cancer staging system indicates the importance of lymph node metastasis in evaluating the prognosis of patients,but there may be some limitations. |
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