| BackgroundGlobally,among all malignant tumors,the incidence rate of new cases and deaths of cervical cancer stay in the high level.In 2017,the incidence rate of new cervical cancer cases in China ranks at the top overall the world.Due to the technology gap between developing and developed countries,the tumor characteristics and patient needs of cervical cancer vary.Majority of patients in developed countries are identified at early cervical cancer stage because of the advanced screening methods.They are eager to receive more advanced treatment and purchase the higher quality life,However,high percentage of patients are identified at late cervical cancer stage in developing countries due to the backward screening methods and limited treatment resources.At present,the internationally widely used cervical cancer staging system is FIGO2018staging system.However,there are still some arguments about this staging system:such as,1)Whether it is meaningful to redivide the original IB period;2)Whether stage ⅢC is scientific according to lymph metastasis;3)There is no hierarchical treatment recommendation for stage ⅢC 1,and whether synchronous radiotherapy and chemotherapy is appropriate is uniformly recommended;4)In the new stage,lymphatic space infiltration was not reflected.The research objective of this project is to validate the FIGO new cervical cancer stage can indicate the prognosis better than the old one in IB and ⅢC,and to analyze the controversy of the new stage and to propose optimization scheme.Data and methodologyFor the first time,629 patients’clinical data of cervical cancer pathological diagnosed are collected in The First Affiliated Hospital of Dalian Medical University.from November 2010 to December 2018,including date of admission,name,age,pathological stage,pathological results,degree of differentiation,lymphatic vessel infiltration etc.The pathological type of study is within the three common types(squamous cell carcinoma,adenocarcinoma and adenosquamous carcinoma).This study used SPSS26.0 software system for statistical analysis.Results1.In FIGO stage IB,the prognosis can be better distinguished by recategorizing patients’tumor size with 2 cm boundary.(1)In stage IB,the degree of differentiation in stage IB2 was lower than that in stage IB1,and deep interstitial infiltration is more common.In the FIGO new stage system,IB stage group was studied by using univairate analysis with Logrank test.The results showed that the survival time had correlation with the deep interstitial infiltration,FIGO stage,and the degree of differentiation.The overall survival ratio of patients in IB1,IB2 and IB3 groups were 97.0%,94.1%and 88.6%,respectively.The survival ratio of stage IB2 was lower than that of stage IB1.The survival ratio difference between the three sub-stages was statistically significant.(2)Multivariate analysis showed that age group,degree of differentiation and FIGO stage had statistically significant effects on patients’survival time2.The patients’survival ratio in stage ⅢC1 is higher than that in stage ⅢB.(1)In stage ⅢC,the patients’survival difference between stage ⅢC1 and ⅢC2was studied with univairate analysis by using Logrank test.The results showed that the survival time had correlation with age group,number of lymph node metastasis and FIGO stage.The difference was statistically significant.By using multivariate analysis with COX risk proportional model,the results showed that FIGO stage was an independent survival risk factors for patients’survival.The patients’survival risk increased with FIGO stage increase.The difference was statistically significant.(2)Through the univairate analysis with Logrank test,the results showed that the patients’survival rate of in stage ⅢC1 was higher than that in stage ⅢB.Through the multivariate analysis with COX risk proportional model,the results showed that FIGO stage was an independent survival risk factors for patients’survival.The patients’survival risk decreased with FIGO stage increase.The difference was statistically significant.3.For the patients in stage ⅢC1,the analysis of T-stage showed that there was a lack of homogeneity within the groupBy using univairate analysis with Logrank test,the patients’survival results within FIGO2018 stage ⅢC1 were analyzed based on T stage.It was shown that the 5-year patients’survival rate within stage ⅢC1 changed significantly with T stage:82.3%in stage T1,71.4%in stage T2,and 37.0%in stage T3.(X~2=20.118,P<0.001).The difference was statistically significant.4.The patients’survival status in of FIGO 2009 stage IB with lymph metastasis was worse than that of patients without lymph metastasis(1)By using univairate analysis with Logrank test,a study was conducted for the patients in 2009 FIGO stage IB1.The result showed that,with and without lymph node metastasis,the patients’survival rate within old stage IB1 had very strong correlation to the status of lymph node metastasis.The difference was statistically significant(X~2=13.471,P<0.001)。(2)By using univairate analysis with Logrank test,a study was conducted for the patients in 2009 FIGO stage IB2.The result showed that,with and without lymph node metastasis,the patients’survival rate within old stage IB2 had very strong correlation to the status of lymph node metastasis.The difference was statistically significant(X~2=39.9,P<0.001).ConclusionThe conclusions below are based on the comprehensive study from the retrospective data of 629 cases in our hospital,(1)Under the new FIGO staging system,stage IB is reclassified based on the 2 cm boundary tumor size but no including positive lymph metastasis.The patients’survival difference is more accurately predicted through this change.(2)Lack of homogeneity and big difference of 5-year survival rate are within stage ⅢC1 because the FIGO new stage system for cervical cancer only takes the impact of patients’prognosis of lymph metastasis but ignores the local tumor TNM stage.Supplemental T staging can significantly improve the differentiation of patients’prognosis.(3)Tumor diameter,lymph node metastasis and differentiation are the key factors to affect the prognosis of cervical cancer.There was no statistical significance between lymphatic space infiltration and survival period. |
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