Clinical Research Papers:
Development and validation of a surgical-pathologic staging and scoring system for cervical cancer
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Shuang Li1,*, Xiong Li1,2,*, Yuan Zhang3,*, Hang Zhou1, Fangxu Tang1, Yao Jia1, Ting Hu1, Haiying Sun1, Ru Yang1, Yile Chen4, Xiaodong Cheng5, Weiguo Lv5, Li Wu4, Jin Zhou1, Shaoshuai Wang1, Kecheng Huang1, Lin Wang1, Yuan Yao1, Qifeng Yang6, Xingsheng Yang6, Qinghua Zhang1,2, Xiaobing Han7, Zhongqiu Lin8, Hui Xing9, Pengpeng Qu10, Hongbing Cai11, Xiaojie Song12, Xiaoyu Tian13, Jian Shen2, Ling Xi1, Kezhen Li1, Dongrui Deng1, Hui Wang1, Changyu Wang1, Mingfu Wu1, Tao Zhu1, Gang Chen1, Qinglei Gao1, Shixuan Wang1, Junbo Hu1, Beihua Kong6, Xing Xie5 and Ding Ma1
1 Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
2 Department of Gynecology and Obstetrics, the Central Hospital of Wuhan, Wuhan, P.R. China
3 Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
4 Department of Gynecologic Oncology, Hunan Province Tumor Hospital, Changsha, P.R. China
5 Women’s Reproductive Health Laboratory of Zhejiang Province, Zhejiang, P.R. China
6 Department of Gynecology and Obstetrics, Qilu Hospital, Shandong University, Shandong, P.R. China
7 Department of Obstetrics and Gynecology, The First Affiliated Hospital, Medical School of Xi’an Jiaotong University, Xi’an, P.R. China
8 Department of Gynecologic Oncology, The Second Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
9 Department of Obstetrics and Gynecology, Xiangfan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Xiangfan, Hubei, P.R. China
10 Tianjin Central Hospital for Gynecology and Obstetrics, Tianjin, P.R. China
11 Department of Gynecologic Oncology, Zhong Nan Hospital, Wuhan University, Wuhan, P.R. China
12 Commercial Vocational Hospital, Wuhan, P.R. China
13 Department of Obstetrics and Gynecology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan, P.R. China
* These authors have contributed equally to this work
Ding Ma, email:
Xing Xie, email:
Beihua Kong, email:
Keywords: cervical cancer, risk factor, FIGO stage, surgical-pathologic stage, SPSs
Received: November 25, 2015 Accepted: January 29, 2016 Published: March 21, 2016
Background: Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs).
Methods: Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2).
Results: In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging.
Conclusions: Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy.
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