| Background and purpose:In October 2018,FIGO published new guidelines for cervical cancer staging,revising stage IB and introducing stage IIIC.In the new stage（FIGO 2018）,patients with pelvic and para-aortic lymph node metastasis were included in stage IIIC,named stage IIIC1and Stage IIIC2,respectively,regardless of local tumor size and invasion degree,and imaging（r）or pathological（p）evidence was indicated.The new staging system emphasizes that lymph node metastasis is an independent factor affecting the prognosis of cervical cancer,but whether the introduction of stage IIIC is reasonable and whether it can effectively predict the survival of these patients is still worth further discussion.The main purpose of this study is to explore whether it is reasonable to classify all patients with stage IB to stage IIIB with lymph node metastasis in the old stage（2009FIGO）into stage IIIC,and to analyze the factors influencing the 5-year survival of stage IIIC patients.Methods:From January 1,2013 to December 31,2015,481 patients with cervical cancer in Harbin Medical University Tumor Hospital who met the inclusion criteria were selected for 5-year survival analysis.All patients were re-staged according to the new staging criteria,and the following studies were carried out:1.Comparison of survival differences between stage IIIC and stage IIIA-IIIB cervical cancer:（1）Comparison of 5-year survival between stage IIIC patients with stage IB-IIB and stage IIIA-IIIB cervical cancer patients with stage IIIA-IIIB lymph node metastasis;（2）Comparison of 5-year survival between stage IIIA-IIIB patients with stage IIIA-IIIB and stage IIIA-IIIB patients;2.Analysis of factors affecting 5-year survival of patients with stage IIIC cervical cancer:（1）Comparison of survival of patients with stage IIIC cervical cancer at different T stages;（2）Survival analysis and comparison of stage IIIC cervical cancer patients with different local tumor sizes;（3）Comparison of survival analysis of stage IIIC cervical cancer patients with different lymph node status;（4）Survival analysis and comparison of stage IIIC patients with IB to IIB stage with lymph node metastasis in old stage;（5）Survival analysis and comparison of stage IIIC cervical cancer patients with different radiotherapy doses in lymph nodes;（6）Survival analysis and comparison of stage IIIC cervical cancer patients with different pathological types;（7）Survival analysis and comparison of stage IIIC cervical cancer patients with different levels of tumor markers before and after treatment;（8）Survival analysis and comparison of IIIC cervical cancer patients with different age of onset,birth,age of first birth,number of abortion,menopause before treatment.In this study,SPSS21.0 statistical software was used for data analysis,Kaplan-Meier was used to create survival curves,and Log-rank test was used to compare the differences among patients in each group.P<0.05 was statistically significant.Results:1.The 5-year overall survival（OS）of stage IIIC cervical cancer patients with old stage IB-IIB and lymph node metastasis was higher than that of stage IIIA-IIIB,and the difference was statistically significant;the 5-year progression free survival（progression free survival,PFS）was not statistically significant.The 5-year OS and PFS of patients with stage IIIC cervical cancer with lymph node metastasis in the old stage IIIA-IIIB were significantly lower than those in stage IIIA-IIIB,the difference of OS was not statistically significant,and the difference of PFS was statistically significant;2.The difference of OS and PFS in 5 years after stage IIIC cervical cancer was grouped according to T stage was statistically significant;3.There were significant differences in OS and PFS in patients with stage IIIC cervical cancer five years after grouping according to local tumor size;4.Compared with 5-year OS and5-year PFS,the difference was statistically significant in patients with stage IIIC cervical cancer;5.There were significant differences in OS and PFS in patients with stage IIIC cervical cancer according to the number of lymph nodes;6.Compared with OS and PFS in 5 years after the patients with stage IIIC cervical cancer were divided into single and bilateral groups according to lymph node involvement,the difference of OS and PFS was statistically significant;7.Five years after the patients with stage IIIC cervical cancer were divided into groups according to whether the abdominal paraaortic lymph nodes were involved or not,the difference of OS and PFS was statistically significant,but the difference of PFS was not statistically significant;8.There was no significant difference in OS and PFS in patients with stage IIIC cervical cancer according to whether the common iliac lymph nodes were involved or not;9.Compared with OS and PFS 5 years after treatment,there was no significant difference in cervical cancer patients with IB-IIB stage and lymph node metastasis;10.There were significant differences in OS and PFS in patients with stage IIIC cervical cancer with lymph node metastasis at the previous stage of IB-IIB;11.There was no significant difference in OS and PFS in patients with stage IIIC cervical cancer five years after grouping according to pathological type;12.After the patients with stage IIIC cervical cancer were grouped according to the range of serum tumor markers before treatment,there was no significant difference in 5-year OS and PFS of SCC and CA125/199;According to whether the serum tumor markers decreased to the normal range after treatment,there were significant differences in OS and PFS 5 years after treatment;13.There was no significant difference between patients with stage IIIC cervical cancer according to age of onset,age of first birth,number of births,number of abortions,menopause and 5-year OS and PFS.Conclusions:1.The 5-year OS of cervical cancer patients with stage IB to IIB and lymph node metastasis was higher than that of stage IIIA to IIIB,and the differences were statistically significant.It is unreasonable to include them in IIIC stage,and other factors such as paracyngeal invasion,tumor size and lymph node status should also be considered.2.The 5-year OS and PFS of patients with old stage IIIA-IIIB cervical cancer with lymph node metastasis were significantly lower than those of stage IIIA-IIIB,with no statistical significance in OS and significant statistical significance in PFS.It is reasonable to include it in IIIC phase.3.There was no statistical significance in 5-year OS and PFS of patients with old stage IB-IIB cervical cancer with lymph node metastasis who underwent surgery and chemoradiotherapy or concurrent chemoradiotherapy.Individualized treatment should be selected according to age and complications.4.High T stage,local tumor diameter≥4cm,lymph node diameter≥30mm,number of lymph nodes>2,bilateral lymph node involvement,lymph node radiotherapy dose less than 60Gy,serum tumor markers not reduced to the normal range after treatment were all independent risk factors for poor prognosis of IIIC cervical cancer patients. |
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