卵巢上皮性癌FIGO 2013年分期和1988年分期比较研究
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摘要
[目的]探讨卵巢上皮性癌FIGO 2013年分期变化的合理性。[方法]选取536例卵巢上皮性癌患者初治病例,整理和分析其临床病理和随访资料,按照FIGO 2013年分期标准进行重新分期,通过比较各期5年生存率以评价2013年分期的合理性。[结果](1)2013年分期中,Ⅰ、Ⅱ、Ⅲ、Ⅳ期各期总体数量未发生变化,总体比较Ⅰ、Ⅱ、Ⅲ、Ⅳ期生存率有统计学差异。(2)1988年分期中,5年生存率分别为ⅠA期91.4%、ⅠB期84.2%、ⅠC期77.9%(P<0.05),Ⅰ期各亚期5年生存率差异有统计学意义;ⅡC期66.4%(ⅡA期仅4例、ⅡB期仅6例);ⅢA期48.6%、ⅢB期43.2%、ⅢC期37.9%;Ⅳ期7.4%。(3)2013年分期中,5年生存率分别为ⅠA期91.4%、ⅠB期84.2%、ⅠC1期80.7%、ⅠC2期78.3%、ⅠC3期75.4%(P<0.05);ⅠC1、ⅠC2、ⅠC3期之间5年生存率差异无统计学意义;ⅡA期74.4%、ⅡB期61.3%(P<0.05);ⅢA1期53.6%、ⅢA2期43.6%、ⅢB期38.2%、ⅢC期23.4%,ⅢA1、ⅢA2期5年生存率之间差异有统计学意义;ⅢA1、ⅢA2、ⅢB、ⅢC期之间5年生存率差异有统计学意义;ⅣA期15.6%、ⅣB期11.4%(P>0.05)。[结论] 1988年分期和2013年分期各期5年生存率从总体上比较有统计学差异,能够比较有效地区分各期预后的差别。2013年分期中的ⅠC期分为ⅠC1、ⅠC2、ⅠC3亚期并不能更好地评估预后。研究结果支持2013年分期中将ⅢA期分为ⅢA1、ⅢA2亚期。2013年分期将Ⅳ期分为ⅣA、ⅣB期似乎并不合理。
[Objective] To evaluate the rationality of the reassignment of FIGO 2013 staging system for epithelial ovarian cancer. [Methods] The clinical data in 536 patients with epithelial ovarian cancer were collected and sorted. Patients were categorized again according to FIGO 2013 staging system. The rationality of FIGO 2013 staging system was assessed through the 5-year survival rate of the sub-stages. [Results] The overall number of the stage Ⅰ,Ⅱ,Ⅲ,Ⅳ was not changed in the FIGO 2013 staging system. The overall survival rate was significant difference. In the FIGO 1988 staging system:the 5-year survival rate was 91.4% in stage ⅠA,84.2% in stage ⅠB,77.9% in stage ⅠC(P<0.05),the 5-year survival rate of stage ⅡC was66.4%(there were only 4 cases of stage ⅡA and 6 cases of sage ⅡB),the 5-year survival of stage Ⅲ was48.6% in stage Ⅲ A,43.2% in stage Ⅲ B,37.9% in stage Ⅲ C,the 5-year survival rate of stage Ⅳ was7.4%. In the FIGO 2013 staging system:the 5-year survival was 91.4% in stage ⅠA,84.2% in stage ⅠB,80.7% in stage ⅠC1,78.3% in stage ⅠC2,75.4% stage ⅠC3(P<0.05). The curves representing the stageⅠC1, ⅠC2,IC3 showed no significant difference between each other(P>0.05),the 5-year survival of was74.4% in stage ⅡA,61.3% in stage ⅡB(P<0.05),the 5-year survival was 53.6% in stage ⅢA1,43.6% in stage ⅢA2,38.2% in stage ⅢB,23.4% in stage ⅢC,there was significant differences between stage ⅢA1 and stage ⅢA2(P<0.05). The curves representing the stage ⅢA1,stage ⅢA2,stage ⅢB,stage ⅢC showed significant difference between each other(P<0.05),The 5-year survival was 15.6% in stage ⅣA,11.4% in stage ⅣB(P>0.05). [Conclusions] The 5-year survival rates of 1988 and 2013 staging can effectively differ the prognosis of all stages. But stage ⅠC1,stage ⅠC2,stage ⅠC3 in the FIGO 2013 staging system can not effectively differ the prognosis. This study supports that it seems unreasonable that the stage ⅢA is categorized into stage ⅢA1,stage ⅢA2 in FIGO 1988 staging and the stage Ⅳ is categorized into stage ⅣA,stage ⅣB in the FIGO 2013 staging system.
[Objective] To evaluate the rationality of the reassignment of FIGO 2013 staging system for epithelial ovarian cancer. [Methods] The clinical data in 536 patients with epithelial ovarian cancer were collected and sorted. Patients were categorized again according to FIGO 2013 staging system. The rationality of FIGO 2013 staging system was assessed through the 5-year survival rate of the sub-stages. [Results] The overall number of the stage Ⅰ,Ⅱ,Ⅲ,Ⅳ was not changed in the FIGO 2013 staging system. The overall survival rate was significant difference. In the FIGO 1988 staging system:the 5-year survival rate was 91.4% in stage ⅠA,84.2% in stage ⅠB,77.9% in stage ⅠC(P<0.05),the 5-year survival rate of stage ⅡC was66.4%(there were only 4 cases of stage ⅡA and 6 cases of sage ⅡB),the 5-year survival of stage Ⅲ was48.6% in stage Ⅲ A,43.2% in stage Ⅲ B,37.9% in stage Ⅲ C,the 5-year survival rate of stage Ⅳ was7.4%. In the FIGO 2013 staging system:the 5-year survival was 91.4% in stage ⅠA,84.2% in stage ⅠB,80.7% in stage ⅠC1,78.3% in stage ⅠC2,75.4% stage ⅠC3(P<0.05). The curves representing the stageⅠC1, ⅠC2,IC3 showed no significant difference between each other(P>0.05),the 5-year survival of was74.4% in stage ⅡA,61.3% in stage ⅡB(P<0.05),the 5-year survival was 53.6% in stage ⅢA1,43.6% in stage ⅢA2,38.2% in stage ⅢB,23.4% in stage ⅢC,there was significant differences between stage ⅢA1 and stage ⅢA2(P<0.05). The curves representing the stage ⅢA1,stage ⅢA2,stage ⅢB,stage ⅢC showed significant difference between each other(P<0.05),The 5-year survival was 15.6% in stage ⅣA,11.4% in stage ⅣB(P>0.05). [Conclusions] The 5-year survival rates of 1988 and 2013 staging can effectively differ the prognosis of all stages. But stage ⅠC1,stage ⅠC2,stage ⅠC3 in the FIGO 2013 staging system can not effectively differ the prognosis. This study supports that it seems unreasonable that the stage ⅢA is categorized into stage ⅢA1,stage ⅢA2 in FIGO 1988 staging and the stage Ⅳ is categorized into stage ⅣA,stage ⅣB in the FIGO 2013 staging system.
引文
[1]Babayeva A,Braicu EI,Grabowski JP,et al.Clinical outcome after completion surgery in patients with ovarian cancer:the charite experience[J].Int J Gynecol Cancer,2018,28(8):1491-1497.
[2]Jiang Y,He W,Yang H,et al.Analysis of clinical effects of neoadjuvant chemotherapy in advanced epithelial ovarian cancer[J].J BUON,2018,23(3):758-762.
[3]Prat J.Ovarian,fallopian tube and peritoneal cancer staging:rationale and explanation of new FIGO staging 2013[J].Best Pract Res Clin Obstet Gynaecol,2015,29(6):858-869.
[4]Kandukuri SR,Rao J.FIGO 2013 staging system for ovarian cancer:what is new in comparison to the 1988 staging system?[J].Curr Opin Obstet Gynecol,2015,27(1):48-52.
[5]Zhang C,Li Y,Cui H.Analysis of the changes of FIGOnew stage in ovarian epithelial cancer in 2013[J].Chin JObstet Gynecol,2015,50(12):957-960.[张琛,李艺,崔恒.卵巢上皮性癌2013年FIGO新分期变化的分析[J].中华妇产科杂志,2015,50(12):957-960.]
[6]Yoshikawa K,Fukuda T,Uemura R,et al.Age-related differences in prognosis and prognostic factors among patients with epithelial ovarian cancer[J].Mol Clin Oncol,2018,9(3):329-334.
[7]Yim GW,Eoh KJ,Kim SW,et al.Malnutrition identified by the nutritional risk index and poor prognosis in advanced epithelial ovarian carcinoma[J].Nutr Cancer,2016,68(5):772-779.
[8]Wang J,Li J,Chen R,et al.Survival effect of different lymph node staging methods on ovarian cancer:an analysis of 10 878 patients[J].Cancer Med,2018,7(9):4315-4329.
[9]Sahin H,Meydanli MM,Sari ME,et al.Does the primary route of spread have a prognostic significance in stageⅢnon-serous epithelial ovarian cancer[J].J Ovarian Res,2018,11(1):21.
[10]Gasimli K,Braicu EI,Nassir M,et al.Lymph node involvement pattern and survival differences of FIGOⅢCand FIGOⅢA1 ovarian cancer patients after primary complete tumor debulking surgery:a 10-year retrospective analysis of the tumor bank ovarian cancer network[J].Ann Surg Oncol,2016,23(4):1279-1286.
[11]Berek JS.Lymph-node positive stageⅢC ovarian cancer:a separate entity?[J].Int J Gynecol Cancer,2009,19(Suppl2):S18-S20.
[12]Paik ES,Lee YY,Lee EJ,et al.Survival analysis of revised2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification[J].Obstet Gynecol Sci,2015,58(2):124-134.
[13]Bakkum-Gamez JN,Richardson DL,Seamon LG,et al.Influence of intraoperative capsule rupture on outcomes in stageⅠepithelial ovarian cancer[J].Obstet Gynecol,2009,113(1):11-17.
[14]Céline MS,Uzma M,Andreas S,et al.Impact of the new FIGO 2013 classification on prognosis of stageⅠepithelial ovarian cancers[J].Cancer Manag Res,2018,10:4709-4718.
[15]Sisovská I,MinaǐL,Felsinger M,et al.Current FIGOstaging classification for cancer of ovary,fallopian tube and peritoneum[J].Ceska Gynekol,2017,82(3):230-236.
[16]Ataseven B,Harter P,Grimm C,et al.The revised 2014FIGO staging system for epithelial ovarian cancer:is a subclassification into FIGO stageⅣA andⅣB justified?[J].Gynecol Oncol,2016,142(2):243-247.
[17]Tajik P,vande VR,Zafarmand MH,et al.The FIGO StageⅣA versusⅣB of ovarian cancer:prognostic value and predictive value for neoadjuvant chemotherapy[J].Int JGynecol Cancer,2018,28(3):453-458.
[2]Jiang Y,He W,Yang H,et al.Analysis of clinical effects of neoadjuvant chemotherapy in advanced epithelial ovarian cancer[J].J BUON,2018,23(3):758-762.
[3]Prat J.Ovarian,fallopian tube and peritoneal cancer staging:rationale and explanation of new FIGO staging 2013[J].Best Pract Res Clin Obstet Gynaecol,2015,29(6):858-869.
[4]Kandukuri SR,Rao J.FIGO 2013 staging system for ovarian cancer:what is new in comparison to the 1988 staging system?[J].Curr Opin Obstet Gynecol,2015,27(1):48-52.
[5]Zhang C,Li Y,Cui H.Analysis of the changes of FIGOnew stage in ovarian epithelial cancer in 2013[J].Chin JObstet Gynecol,2015,50(12):957-960.[张琛,李艺,崔恒.卵巢上皮性癌2013年FIGO新分期变化的分析[J].中华妇产科杂志,2015,50(12):957-960.]
[6]Yoshikawa K,Fukuda T,Uemura R,et al.Age-related differences in prognosis and prognostic factors among patients with epithelial ovarian cancer[J].Mol Clin Oncol,2018,9(3):329-334.
[7]Yim GW,Eoh KJ,Kim SW,et al.Malnutrition identified by the nutritional risk index and poor prognosis in advanced epithelial ovarian carcinoma[J].Nutr Cancer,2016,68(5):772-779.
[8]Wang J,Li J,Chen R,et al.Survival effect of different lymph node staging methods on ovarian cancer:an analysis of 10 878 patients[J].Cancer Med,2018,7(9):4315-4329.
[9]Sahin H,Meydanli MM,Sari ME,et al.Does the primary route of spread have a prognostic significance in stageⅢnon-serous epithelial ovarian cancer[J].J Ovarian Res,2018,11(1):21.
[10]Gasimli K,Braicu EI,Nassir M,et al.Lymph node involvement pattern and survival differences of FIGOⅢCand FIGOⅢA1 ovarian cancer patients after primary complete tumor debulking surgery:a 10-year retrospective analysis of the tumor bank ovarian cancer network[J].Ann Surg Oncol,2016,23(4):1279-1286.
[11]Berek JS.Lymph-node positive stageⅢC ovarian cancer:a separate entity?[J].Int J Gynecol Cancer,2009,19(Suppl2):S18-S20.
[12]Paik ES,Lee YY,Lee EJ,et al.Survival analysis of revised2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification[J].Obstet Gynecol Sci,2015,58(2):124-134.
[13]Bakkum-Gamez JN,Richardson DL,Seamon LG,et al.Influence of intraoperative capsule rupture on outcomes in stageⅠepithelial ovarian cancer[J].Obstet Gynecol,2009,113(1):11-17.
[14]Céline MS,Uzma M,Andreas S,et al.Impact of the new FIGO 2013 classification on prognosis of stageⅠepithelial ovarian cancers[J].Cancer Manag Res,2018,10:4709-4718.
[15]Sisovská I,MinaǐL,Felsinger M,et al.Current FIGOstaging classification for cancer of ovary,fallopian tube and peritoneum[J].Ceska Gynekol,2017,82(3):230-236.
[16]Ataseven B,Harter P,Grimm C,et al.The revised 2014FIGO staging system for epithelial ovarian cancer:is a subclassification into FIGO stageⅣA andⅣB justified?[J].Gynecol Oncol,2016,142(2):243-247.
[17]Tajik P,vande VR,Zafarmand MH,et al.The FIGO StageⅣA versusⅣB of ovarian cancer:prognostic value and predictive value for neoadjuvant chemotherapy[J].Int JGynecol Cancer,2018,28(3):453-458.