The prognostic value of revised 2018 FIGO stage ⅢC in cervical cancer

龙行涛; 周 琦; 陈月梅; 金福军

doi:10.19401/j.cnki.1007-3639.2021.08.005

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The prognostic value of revised 2018 FIGO stage ⅢC in cervical cancer

更新时间：2025-12-31

- The prognostic value of revised 2018 FIGO stage ⅢC in cervical cancer
- China Oncology Vol. 31, Issue 8, Pages: 725-733(2021)
- 作者机构：
  
  1. 重庆大学附属肿瘤医院妇科肿瘤中心,重庆,400030
  2. 重庆市东南医院肿瘤科,重庆,401336
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2021.08.005
  CLC：
- Published Online：03 September 2021，
  
  Published：03 September 2021
- 稿件说明：
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龙行涛, 周琦, 王冬, 陈月梅, 金福军 . 子宫颈癌2018年FIGO新分期ⅢC期患者预后分析[J]. 中国癌症杂志, 2021, 31(8): 725-733.

龙行涛, 周琦, 陈月梅, et al. The prognostic value of revised 2018 FIGO stage ⅢC in cervical cancer[J]. China Oncology, 2021, 31(8): 725-733.
龙行涛, 周琦, 王冬, 陈月梅, 金福军 . 子宫颈癌2018年FIGO新分期ⅢC期患者预后分析[J]. 中国癌症杂志, 2021, 31(8): 725-733. DOI： 10.19401/j.cnki.1007-3639.2021.08.005.

龙行涛, 周琦, 陈月梅, et al. The prognostic value of revised 2018 FIGO stage ⅢC in cervical cancer[J]. China Oncology, 2021, 31(8): 725-733. DOI： 10.19401/j.cnki.1007-3639.2021.08.005.

摘要

背景与目的：国际妇产科联盟（International Federation of Gynecology and Obstetrics，FIGO）2018年子宫颈癌新分期增加了ⅢC期。但是，ⅢC期这类患者存在高度异质性，其预后差异可能较大。探讨子宫颈癌2018年FIGO新分期系统对ⅢC期患者预后的预测价值。方法：采用病例对照研究方法，根据纳入和排除标准，连续收集2011年1月—2014年12月重庆大学附属肿瘤医院妇科肿瘤中心收治的子宫颈癌Ⅲ期患者的临床病历资料，回顾性分析生存状况及影响预后的相关因素。采用Kaplan-Meier法计算生存率；单因素生存分析采用log-rank检验；多因素生存分析采用COX比例风险回归模型。结果：纳入研究病例418例，其中ⅢA期42例（10.0%），ⅢB期120例（28.7%），ⅢC1期190例（45.5%），ⅢC2期66例（15.8%）。在4组人口学特征中，年龄差异有统计学意义（P=0.003）；其他包括组织学类型、组织分化、肿瘤大小、放射治疗类型、是否巩固化疗差异均无统计学意义（P0.05）。生存分析显示，ⅢC1期患者5年生存率为54.1%，高于ⅢB期的40.6%及ⅢA期的43.3%，但差异无统计学意义（P=0.042及P=0.484）。ⅢC2期患者5年生存率仅为23.1%，均显著低于其他组（P0.01）。多因素模型分析显示，ⅢC1期较ⅢA（HR=1.432，95% CI：0.867~2.366，P=0.161）和ⅢB期（HR=1.261

95% CI：0.871~1.827，P=0.219）均没有明显增加死亡风险；ⅢC2期独立增加死亡风险为ⅢA期近3倍（HR=2.958，95%CI：1.757~4.983，P0.001）。基于T分期ⅢC1期患者预后存在显著差异（5年生存率T 1 为72.2% ，T 2 为54.1%，T 3 为18.6%，P0.001）。多因素模型分析显示，T分期是影响ⅢC1期患者预后的独立危险因素（P0.001）。ⅢC1（T

）期患者5年生存率反而显著高于ⅢA期（P=0.004）和ⅢB期（P0.001）。基于病理学分期及影像学分期ⅢC1期患者预后差异显著，ⅢC1p（T

）期患者5年生存率为64.5%，明显高于ⅢC1r（T

）期的34.9%（P0.001）；ⅢC1p（T

）期患者预后反而显著优于ⅢB期患者（P0.001）。结论：ⅢC2期能准确预测预后，但ⅢC1期患者预后异质性较大，其预后判断还需要结合T分期。

Abstract

Background and purpose: The International Federation of Gynecology and Obstetrics (FIGO) 2018 revised the staging system for cervical cancer with new stage ⅢC. However

patients with stage ⅢC exhibit heterogeneous clinical characteristics

and the prognosis is different. This study aimed to investigate the prognostic value of 2018 FIGO new stage system for cervical cancer patients in stage ⅢC. Methods: A case-control study was conducted to collect the clinical data of patients with stage Ⅲ cervical cancer treated in Gynecological Oncology Center

Chongqing University Cancer Hospital from January 2011 to December 2014 according to the inclusion and exclusion criteria. The survival status and prognostic factors were analyzed retrospectively. Kaplan-Meier method was used to calculate the survival rate. Log-rank test was used for univariate survival analysis

and Cox proportional hazards regression model was used for multivariate survival analysis. Results: A total of 418 cases were included in the study

in which stage ⅢA had 42 cases (10.0%)

stage ⅢB had 120 cases (28.7%)

stage ⅢC1 had 190 cases (45.5%) and stage ⅢC2 had 66 cases (15.8%). There was significant difference in age among the four groups (P=0.003). There was no significant difference in histological type

histological differentiation

tumor size

radiotherapy type and consolidation chemotherapy (P0.05). Survival analysis showed that the 5-year overall survival (OS) rate of stage ⅢC1 disease was 54.1%

higher but not statistically significant compared with stage ⅢB (40.6%

P=0.042) and ⅢA (43.3%

P=0.484). The stage ⅢC2 had a significantly worse OS compared with stage ⅢC1

ⅢA and ⅢB (P0.01)

and 5-year OS rate was 23.1% for ⅢC2. Multivariate analysis showed that the stage ⅢC1 disease did not increase the risk of death compared with stage ⅢA (HR=1.432

95% CI: 0.867-2.366

P=0.161) and ⅢB (HR=1.261

95% CI: 0.871-1.827

P=0.219). The risk of death was nearly 3 times higher in ⅢC2 than in ⅢA (HR=2.958

95% CI:

1.757-4.983

P0.001). The survival of stage ⅢC1 disease differed significantly based on T stage (P0.001). Multivariable analysis showed T stage remained an independent prognostic factor for survival in patients with stage ⅢC1 disease

and 5-year OS rate was 72.2% for T

54.1% for T

and 18.6% for T 3 ( P0.001). The 5-year OS rate of stage ⅢC1 (T

) patients was 72.2% with better 5-year OS compared with stage ⅢA (P=0.004) and ⅢB (P0.001). Based on the pathological stage and imaging stage

the 5-year OS rate of stage ⅢC1p (T

) was 64.5%

which was significantly higher compared with stage ⅢC1r (T

) (34.9%

P0.001). The prognosis of patients with stage ⅢC1p (T

) was significantly better than that of patients with stage ⅢB (P0.001). Conclusion: The prognosis of patients with stage ⅢC2 disease has distinct characteristics. However

the stage ⅢC1 is heterogeneous

and its prognostic evaluation should be combined with T stage.

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