| Objective:Explore the overall cervical cancer staging system of FIGO 2018 and the ability of each stage to predict the prognosis,look for whether there are stages that cannot be more accurately judged and analyze the possible influencing factors.In addition,analyze the factors that are not involved in the FIGO 2018 staging system,to provide a basis for further improving the FIGO cervical cancer staging system.Methods:A retrospective case study was used to select cervical cancer patients who were newly treated in the Department of Gynecological Oncology,Jiangxi Maternity and Child Health Hospital from January 2013 to December 2017 in strict accordance with the admission criteria.According to the FIGO 2018 cervical cancer staging system,after re-staging,the ROC curve and the area under the curve(AUC value) are first used to compare the overall prognostic performance of the two versions of the staging system,then use survival analysis Kaplan-Meier method,Log rank test,Kruskal-Wallis H test between K samples and Bonferroni correction method to compare the two versions of the staging system as a whole and each stage to compare the horizontal and vertical prognosis to determine whether If the prognosis cannot be judged more accurately,then further analyze the possible influencing factors that lead to the result(after univariate survival analysis finds out the influential factors,then further use the COX proportional hazard regression model to analyze the independent risk factors),and finally For the factors not involved in the revised staging system,the survival analysis method is also used for preliminary analysis and discussion.P<0.05 in all tests indicates that the results are statistically significant.Results:1.Overall information: A total of 2113 patients were enrolled,ranging in age from 24-69 years old,with a median age of 52 years old.There were 1817 cases(85.99%)of pathological type squamous cell carcinoma,204 cases(9.66%)of adenocarcinoma and 92 cases of adenosquamous carcinoma(4.35%).The follow-up ended on November 30,2020,the follow-up time was 2-94 months,and the median follow-up time was 58 months.According to the FIGO 2018 cervical cancer staging system,709 cases(33.55%)in stage IB2,134 cases in stage ⅢC1r(6.34%),117 cases in stage ⅢC1p(5.54%),and 30 cases in stage ⅢC2r(1.42%)),5 cases(0.24%)in stage ⅢC2 p.2.The area under the curve of the FIGO 2009 and 2018 cervical cancer staging ROC curves are 0.720 and 0.780,respectively,indicating that the predictive capabilities of the two staging systems have certain accuracy,but the prognostic predictive ability of the 2018 staging is better than that of the 2009 staging.And the difference was statistically significant(P<0.05).3.Horizontal and vertical comparison of the survival situation of the two editions of staging system:Horizontal comparison: When comparing the 5-year OS and 5-year DFS of each period in the FIGO 2018 and 2009 cervical cancer staging systems,only the overall prognostic difference between stage ⅠB2 and stage ⅠB is statistically significant.Although the prognosis of the remaining periods was different in the horizontal comparison,the difference was not statistically significant.There was no change in the ⅣB stage between the two stages,and no statistical analysis was performed.Overall comparison: The overall survival analysis(respective longitudinal) of the FIGO 2009 version and 2018 version of cervical cancer staging has a statistically significant difference in 5-year OS and DFS(P<0.001).Longitudinal pairwise comparison:FIGO 2009 Cervical Cancer Stages Pairwise Comparison of 5-year OS and DFS Survival Differences Significantly exist between ⅠB1 and ⅠB2 and between ⅢB and ⅡB1,ⅡA1,and ⅡB;The difference in the remaining periods is not statistically significant.FIGO 2018 cervical cancer stage pairwise comparison of prognosis in addition to the significant differences between stage ⅠB2 and ⅠB3,and between stage ⅢB and stage ⅠB2,ⅠB3,and ⅡA1,There are also between ⅢC1 and ⅠB2,ⅠB3,ⅡA1,and between ⅢC2 and ⅠB1,ⅠB2,ⅠB3,ⅡA1,ⅡA2,and IIB,And the prognosis of ⅢC1 and ⅢC2 are also significantly different.In the pairwise comparison,it can be concluded that the prognosis of FIGO 2018 stage ⅢC1 and ⅢB is not much different,and the 5-year OS and DFS of the two are relatively meaningless.In addition,the comparison of 5-year OS and DFS between stage ⅢC2,stage ⅢC1,and stage ⅣB showed that the survival of stage ⅢC2 was significantly lower than that of stage ⅢC1 and was meaningful,and was closer to stage ⅣB.In addition,a multivariate analysis for each sub-period of FIGO 2018 staging ⅠB stage showed that the death risk of ⅠB3 stage was about three times that of ⅠB2 stage(P=0.008).4.Analysis of relevant influencing factors of stage ⅢC: Univariate survival analysis showed that different diagnostic methods(pathology or imaging),tumor diameter,periuterine tissue condition of gynecological examination,vaginal involvem-ent,lymph node size and number are all factors affecting the prognosis of stage ⅢC1(P<0.05);multivariate analysis showed that the poor flexibility of gynecolo-gical examination was an independent risk factor for the prognosis of patients with stage ⅢC(P=0.045),and patients with stage ⅢC2 were twice as likely to die as patients with stage ⅢC1(P=0.010).5.Analysis of factors not involved in FIGO 2018 cervical cancer staging system:Uterine body involvement: There is a statistically significant difference in 5-year OS and DFS between those with and without uterine body involvement(P<0.001),Separate statistics according to pathology and imaging showed that both were meaningful(P<0.05).Accessory involvement: Postoperative pathology showed that there were 7 patients with accessory involvement.The sample size of the study data was too small to analyze the impact of accessory involvement on the prognosis of cervical cancer.Conclusions:1.The 2018 version of FIGO cervical cancer staging and prognosis prediction ability is better than the 2009 version;2.FIGO 2018 staging ⅢC1 and ⅢB and ⅢC2 and IVB have no difference in prognostic ability.The prognosis of stage ⅢC1 is heterogeneous,and its survival outcome will be affected by factors such as diagnosis method,tumor size,periuterine tissue condition of gynecological examination,vaginal involvement,size and number of lymph nodes,especially the influence of periuterine tissue condition of gynecological examination.In the phase ⅢC1 study,the status of local tumors and lymph nodes should be further subdivided,and in addition,it should be further analyzed whether the ⅢC2 phase can be merged into the ⅣB phase;3.Uterine body involvement is an important factor in the prognosis of cervical cancer regardless of imaging and pathology,and uterine body involvement should be involved in future staging. |
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