Abstract:

Objective To compare the differences in distribution and prognosis of cervical cancer patients in the 2009 and 2018 editions of International Federation of Gynecology and Obstetrics (FIGO) staging, and to analyze the prognostic factors of cervical cancer patients. Methods The clinical data of 524 cervical cancer patients admitted to the First Affiliated Hospital of Soochow University from January 2010 to December 2018 were retrospectively analyzed. The cases were staged according to the 2009 and 2018 FIGO staging, and the Kendall τb coefficient was calculated to compare the consistency of the distribution of the two stages. Kaplan-Meier was used for survival analysis, and log-rank test was used to test the difference of prognosis in each stage. Cox-regression was used to analyze the prognostic factors of cervical cancer patients. Results In the 2009 FIGO edition of staging, 1 case of stage ⅠB1 was reduced to stage ⅠA1 due to the microscopic infiltration depth <5 mm, 51 cases of stage ⅠB1 were raised to stage ⅠB2 due to 2 cm<the maximum diameter of the tumor≤4 cm, and 43 cases of stage ⅠB2 were raised to stage ⅠB3 due to the maximum diameter of the tumor>4 cm. A total of 119 cases raised to stage ⅢC1 due to pelvic lymph node metastasis, and 11 cases raised to stage ⅢC2 due to para-aortic lymph node metastasis. The distribution of cases in the two stages was consistent (τb=0.61, P<0.001). There were statistically significant differences in overall survival (OS) (χ ²=107.13, P<0.001; χ ²=93.02, P<0.001; χ ²=92.74, P<0.001) and progression-free survival (PFS) (χ ²=91.95, P<0.001; χ ²=77.69, P<0.001; χ ²=73.27, P<0.001) among patients with different stages of FIGO in 2018 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, ⅢC1, ⅢC2, Ⅳ) and 2009 (ⅠA, ⅠB, Ⅱ, ⅢA, ⅢB, Ⅳ) and patients with different T stages (T₁, T₂, T₃, T₄). There were statistically significant differences in OS (χ ²=20.71, P<0.001) and PFS (χ ²=24.25, P<0.001) in 2018 FIGOⅠB and ⅢC stages, and there was a statistically significant difference in OS between stage ⅢC1 and stage ⅠB2 (χ ²=6.18, P=0.013). Multivariate analysis showed that age (HR=1.88, 95%CI: 1.08-3.28, P=0.026), pathological type (HR=2.11, 95%CI: 1.04-4.27, P=0.038), lymph node metastasis (HR=2.18, 95%CI: 1.34-3.56, P=0.002), parametrial spread (HR=2.56, 95%CI: 1.52-4.29, P<0.001), maximum tumor diameter (HR=1.98, 95%CI: 1.18-3.30, P=0.009), squamous cell carcinoma antigen (SCCA) positive after treatment (HR=4.49, 95%CI: 2.09-9.68, P<0.001) and Hemoglobin (HB) level before treatment (HR=0.58, 95%CI: 0.35-0.96, P=0.035) were independent risk factors for OS in patients with cervical cancer. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅠB1, ⅠB2, ⅠB3 were 100%, 97.1% and 87.9% respectively, with a statistically significant difference (χ ²=7.79, P=0.020), and there was a statistically significant difference between stage ⅠB1 and ⅠB3 (χ ²=5.55, P=0.019). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅠB1 and ⅠB2 were 95.7% and 84.3% respectively, with a statistically significant difference (χ ²=9.08, P=0.003). For patients with 2018 FIGO stage ⅠB, SCCA positive after treatment (HR=1 172.50, 95%CI: 10.37-132 554.51, P=0.003) was an independent risk factor for OS, and differentiation degree (HR=0.09, 95%CI: 0.01-0.81, P=0.032), treatment method (HR=0.17, 95%CI: 0.04-0.71, P=0.015) and SCCA positive after treatment (HR=190.68, 95%CI: 14.27-2 547.67, P<0.001) were independent risk factors for PFS. For patients with 2018 FIGO stage ⅠB, stage (HR=9.56, 95%CI: 2.38-38.32, P=0.001), SCCA positive after treatment (HR=126.32, 95%CI: 12.36-1 290.60, P<0.001) and lymph node metastasis (HR=20.07, 95%CI: 3.63-111.11, P=0.001) were independent risk factors for OS, and differentiation degree (HR=0.11, 95%CI: 0.02-0.63, P=0.013), treatment method (HR=0.22, 95%CI: 0.06-0.75, P=0.015) and SCCA positive after treatment (HR=43.83, 95%CI: 7.94-241.84, P<0.001) were independent risk factors for PFS. According to the 2018 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 95.7% and 75.6% respectively, with a statistically significant difference (χ ²=13.96, P<0.001). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 83.1% and 67.1% respectively, with a statistically significant difference (χ ²=7.61, P=0.006). According to the 2009 FIGO stage, the 5-year OS rates of patients with stage ⅡA and ⅡB were 90.9% and 75.0% respectively, with a statistically significant difference (χ ²=8.85, P=0.003). The 5-year PFS rates of patients with stage ⅡA and ⅡB were 75.7% and 66.7% respectively, with a statistically significant difference (χ ²=4.07, P=0.044). For patients with 2018 FIGO stage Ⅱ, pathological type (HR=20.28, 95%CI: 2.93-140.32, P=0.002) and stage (HR=4.35, 95%CI: 1.02-18.55, P=0.047) were independent risks factors for OS. For patients with 2009 FIGO stage Ⅱ, pathological type (HR=5.82, 95%CI: 1.62-20.94, P=0.007) was an independent risk factor for OS, and pathological type (HR=3.09, 95%CI: 1.22-7.85, P=0.017) and lymph node metastasis (HR=2.07, 95%CI: 1.22-3.51, P=0.007) were independent risk factors for PFS. For patients with 2018 FIGO stage Ⅲ, maximum tumor diameter (HR=3.31, 95%CI: 1.45-7.56, P=0.005) and SCCA positive after treatment (HR=4.67, 95%CI: 1.22-17.86, P=0.024) were independent risk factors for OS, and pathological type (HR=4.15, 95%CI: 1.47-11.77, P=0.007) and SCCA positive after treatment (HR=3.96, 95%CI: 1.45-10.86, P=0.007) were independent risk factors for PFS. Conclusion The 2018 and 2009 FIGO staging have a good distribution consistency in the cervical cancer patients, and the 2018 FIGO stage ⅠB has more advantages in judging the prognosis, but stage ⅢC cannot accurately judge the prognosis. Lymph node metastasis and maximum tumor diameter are more important prognostic factors.

Key words: Cervical neoplasms, Neoplasm staging, FIGO, Prognosis