Validation Of The 2018 FIGO Cervical Cancer New Staging System

Objective:In 2018,International Federation of Gynecology and Obstetrics(FIGO)proposed a new staging system for cervical cancer,which promoted the progress of disease diagnosis and treatment and brought some controversy.This study was designed to validate the new staging system of the cervical cancer and provide revisions to its shortcomings.Methods:A retrospective analysis was performed on 1257 patients with cervical cancer who were first diagnosed with cervical cancer from December 2012 to December2014 in the Department of Jiangxi Maternal and Child Health Hospital.Based on the clinical data and follow-up data of these cases,the new cervical cancer staging system was evaluated and validated,and the amendment suggestions were put forward.Result:1.1257 patients,compared with the old stage,409 patients(32.5%)had stage changes.One case(0.1%)of IA2 patients increased to stage ⅢC1 because of pelvic lymph node positive.173 cases(13.7%)of IB1 patients changed in stages.124 cases(9.8%)rose to stage IB2,49 cases(3.8%)rose to stage ⅢC1.Of the patients in stage IB2,67 cases(5.3%)rose to stage IB3,29 cases(2.3%)rose to stage ⅢC1,and 1case(0.1%)rose to stage ⅢC2.Of the patients in stage IIa,32 cases(2.5%)increased to stage ⅢC1,103 cases(8.1%)to stage ⅢC1 and 1 cases(0.1%)to stage ⅢC2,.Six patients(0.5%)in stage IIIA went up to stage ⅢC1,106 patients(8.4%)in stage IIIB went up to stage ⅢC1,and 14 patients(0.2%)went up to stage ⅢC2.2.In the staging IB cohort,a total of 29 patients(8.0%)died,with a median follow-up of 60(9-72)months.Among them,the overall survival rate was 96.5% in IB1,90.3% in IB2,and 83.6% in IB3.The difference was statistically significant(P =0.005).3.In the staging ⅢC cohort,a total of 55 patients(27.7%)died,with a median follow-up time of 55(3-72)months.The total survival rate of pathologically diagnosed ⅢC1 p was 77.0% and the total survival rate of ⅢC1 r diagnosed by imaging was 73.4%,,and the difference was not statistically significant(P-value0.506).The total survival rate of ⅢC2 p diagnosed by pathology and ⅢC2 r diagnosed by imaging was 25% and 33.3%,respectively,and the difference was not statistically significant(P-value 0.359).To check the overall survival rate of stage III,the overall survival rate of patients in stage IIIA was 78.5%,the overall survival rate of patients in stage IIIB was 67.7%,the overall survival rate in patients with stage ⅢC1 was74.2%,and the overall survival rate in patients with stage ⅢC2 was 31.3%.The difference was statistically significant.(P value <0.01).According to the T stage,patients with stage ⅢC were divided into three cohorts to test their overall survival rate.The overall survival rate in T1 was 84.8%,the overall survival rate in T2 was75.6%,and the overall survival rate in T3 was 65.2%.The difference was statistically significant(P Value <0.01).4.Compared with the old and new stages,the ROC curves of the old and new stages were drawn with the total survival rate as the state variable.The area under the curve was 0.699 and 0.694,respectively.There was no difference between the old and new stages in predicting the prognosis of patients(P=0.91).On this basis,a new stage revision is proposed.ROC area is 0.714,and the revised stage area is larger than the new stage system.We also calculated the consistency index of 0.6954(95%CL0.657-0.7182)and 0.688(95% CL0.657-0.718),respectively.The revised stage is slightly higher than the 2018 stage.These results suggest that the modified staging can be more effective in assessing the severity of the disease and the prognosis of the patients.Conclusion:The new FIGO cervical cancer staging system is helpful to further differentiate the survival groups of patients,especially in the newly added IB1 and IB2 stages,whose disease characteristics and survival outcomes are significantly different,which is helpful to guide clinical decision-making and prognostic evaluation.Theintroduction of imaging staging system can reduce unnecessary surgery and reduce the risk of complications,but the proposed stage ⅢC can not evaluate the prognosis very well.Moreover,the survival outcome of stage ⅢC1 patients is affected by local factors of tumors.We still need to further verify and revise the new staging system.