Analysis Of 2018FIGO Staging System For Cervical Cancer Based On Surgical Pathologic Risk Factors

Background:Due to the high incidence of cervical cancer,the diagnosis and treatment of cervical cancer has attracted much attention.The diagnosis and treatment of cervical cancer is mainly based on the FIGO cervical cancer staging system.In October 2018,the International Federation of Gynecology and Obstetrics made a major change to this cervical cancer staging system.Objective:The purpose of this study was to explore the rationality of the inclusion of surgical pathologic risk factors in the cervical cancer staging system revised by the International Federation of Gynecology and Obstetrics in 2018,and focused on the heterogeneity of stage IIIC1p defined by this new staging system.Methods:This study retrospectively analyzed the medical record information of 3993patients.1656 patients met the inclusion criteria.Each patient was restaged according to 2018FIGO staging system.The constituent ratios of each staging system were calculated respectively to compare the distribution of patients in the two staging system;the Mantel-Haenszel chi-square test and Pearson correlation coefficient were adopted to explore the relationship between cumulative surgical pathologic risk factors and stage;the survival rates of patients in the adjacent stages of the two staging systems were compared;univariate analysis and multivariate analysis were used to investigate the surgical pathologic risk factors affecting the prognosis of cervical cancer;the surgical pathologic risk factors influencing the prognosis of stage IIIC1p patients were screened and then the heterogeneity of stage IIIC1p was discussed.Results:1.For 2009FIGO staging system,the case constituent ratio of each phase was:7.548%for IA1,3.200%for IA2,57.669%for IB1,12.802%for IB2,14.372%for IIA1,and4.408%for IIA2.For 2018FIGO staging system,the case constituent ratio of each phase was:7.186%for IA1,3.623%for IA2,28.019%for IB1,22.645%for IB2,12.319%for IB3,11.413%for IIA1,3.925%for IIA2,9.722%for IIIC1p,and 1.147%for IIIC2p.2.For 2009FIGO staging system,Mantel-Haenszel chi-square test results showed a linear relationship between cumulative surgical pathologic risk factors and stage,x~2=111.862,P<0.001.Pearson correlation results showed that R=0.260,P<0.001.For2018FIGO staging system,Mantel-Haenszel chi-square test results showed a linear relationship between cumulative surgical pathologic risk factors and stage,x~2=706.788,P<0.001.Pearson correlation results showed that R=0.654,P<0.001.3.The 5-year overall survival rate of each stage of 2009FIGO staging system was 99.30%for stage IA,92.77%for stage IB,and 88.46%for stage IIA(x~2=18.389,P<0.001);the 5-year disease-free survival rate was 96.58%for stage IA,88.26%for stage IB,and80.59%for stage IIA(x~2=27.172,P<0.001).The 5-year overall survival rate of each stage of the 2018FIGO staging system was 99.30%for stage IA,94.63%for stage IB,89.46%for stage IIA,and 78.95%for stage IIICp(x~2=62.415,P<0.001);the 5-year disease-free survival rate was 96.61%for stage IA,90.17%for stage IB,84.24%for stage IIA,and 70.23%for stage IIICp(x~2=74.449,P<0.001).The Log-rank test was used to compare the survival rates of the above patients in adjacent stages,and the differences were significant.4.For disease-free survival rate,univariate and multivariate analysis showed that pathological type,myogenous invasion depth,vaginal involvement,uterine involvement,and lymph node involvement were prognostic risk factors of cervical cancer.For overall survival rate,univariate and multivariate analyses showed that pathological type,myogenous invasion depth,vaginal involvement,tubo-ovarian involvement,and lymph node involvement were prognostic risk factors of cervical cancer.5.Univariate and multivariate analysis showed that pelvic lymph node involvement(1-2 lymph node involvement vs more than 2 lymph node involvement)was a risk factor influencing the prognosis of patients with stage IIIC1p cervical cancer.For 2018FIGO staging system,the survival rate was no difference between IIIC1p with 1-2 lymph node involvement and IIA that diagnosed by 2018FIGO staging system.Conclusion:1.Due to the inclusion of surgical pathologic risk factors,the 2018FIGO staging system are better at distinguishing the prognosis of patients than the 2009FIGO staging system,suggesting that the inclusion of surgical pathologic risk factors in the 2018FIGO staging system is reasonable.2.Pathological type,myogenous invasion depth,vaginal involvement,uterine involvement,and lymph node involvement are independent risk factors for the DFS of cervical cancer prognostic.Pathological type,myogenous invasion depth,vaginal involvement,tubo-ovarian involvement,and lymph node involvement are independent risk factors for the OS of cervical cancer prognostic.3.For 2018FIGO staging system,the prognostic of partial stage IIIC1p patients is slightly below stage IIA patients that diagnosis by 2018FIGO staging system,and better than stage IIIA that diagnosed by 2018FIGO staging system.Therefore,in the2018FIGO staging system,the diagnosis of patients with lymph node involvement as stage IIIC needs further discussion.In the stage of IIIC1p diagnosed by 2018FIGO staging system,there are differences in the prognosis of patients with different number of lymph node involvement,so it suggests that the number of lymph node involvement can be subdivided.