Lewin SN, Herzog TJ, Barrena Medel NI, Deutsch I, Burke WM, Sun X, et al.. Comparative performance of the 2009 International Federation of Gynecology and Obstetrics staging system for uterine corpus cancer

Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, the Herbert Irving Comprehensive Cancer Center, New York, New York, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 11/2010; 116(5):1141-9. DOI: 10.1097/AOG.0b013e3181f39849
Source: PubMed


To perform a population-based analysis comparing the performance of the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) staging systems.
Women with endometrioid adenocarcinoma of the uterus treated between 1988 and 2006 and recorded in the Surveillance, Epidemiology, and End Results database were analyzed. Women were classified based on 1988 and 2009 FIGO staging systems. Major changes in the 2009 system include: 1) classification of patients with stage IA and IB tumors as stage IA; 2) elimination of stage IIA; and 3) stratification of stage IIIC into pelvic nodes only (IIIC1) or paraaortic nodal (IIIC2) involvement. Survival and use of adjuvant therapy were analyzed.
A total of 81,902 women were identified. Based on the 1988 staging system, survival for stage IA was 90.7% (95% confidence interval [CI], 90-91%) compared with 88.9% (95% CI 88-89%) for IB tumors. In the 2009 system, survival was 89.6% (95% CI 89-90%) for stage IA and 77.6% (95% CI 76-79%) for stage IB. The survival for FIGO 1988 stage IIA was superior to stage IC, whereas in the 2009 system, survival for stage II was inferior to all stage I patients. The newly defined stage IIIC substages are prognostically different. Survival for stage IIIC1 was 57.0% (95% CI 54-60%) compared with 49.4% (95% CI 46-53%) for stage IIIC2.
The 2009 FIGO staging system for uterine corpus cancer is highly prognostic. The reduction in stage I substages and the separation of stage III will further clarify important prognostic features.

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    • "The prognostic performances of the 1988 and 2009 FIGO staging systems have been compared using the concordance indexes. The FIGO staging systems were not significantly different [5] [6]. However, other studies have suggested that the 2009 FIGO staging system for EC is highly prognostic [7] [8], particularly because stages IIIC1 and IIIC2 have different prognoses (5-year overall survivals are 57% and 49%, respectively [7]) "
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    ABSTRACT: Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors, and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification. Radiological examination methods such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good-enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming increasingly valuable to exclude lymph node metastasis in low-risk groups, and biomarkers could help to identify patients with high-risk lymph node metastatic probability. The therapeutic role of lymph node dissection remains a matter of debate. Several end points can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer. First, we compare survival according to the realization, the extent, and the numbers of nodes removed during lymphadenectomy. Second, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Third, we analyze the surgical complication rate after pelvic lymphadenectomy. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Best practice & research. Clinical obstetrics & gynaecology 03/2015; 29(6). DOI:10.1016/j.bpobgyn.2015.02.007 · 1.92 Impact Factor
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    • "At the time of clinical diagnosis, it has been estimated that approximately 75% of endometrial cancer patients have early stage disease (FIGO stage I and II) with a 5-year overall survival of 80% to 90% [4] [5]. However, nearly 10% to 15% of patients with early-stage disease develop recurrences after the primary surgical treatment [6] [7]. "
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    ABSTRACT: Management of endometrial cancer can be very challenging, even for early-stage disease. The objective of the chapter is to comprehensively shed light on the past, present and future perspectives on the different treatment modalities employed in the management of endometrial cancer.
    Contemporary Gynecologic Practice, 1 edited by Dr. Atef Darwish, 02/2015: chapter 8: pages 157-181; INTECH., ISBN: 978-953-51-1736-0
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    • "Whether or not these patients might benefit from other adjuvant therapy, such as systemic chemotherapy , is currently under investigation by groups such as the Gynecologic Oncology Group (GOG 249; NCT00807768). Notably, the present study broadens the findings of GOG 33 by describing the incidence of regional lymph node metastases in stage II endometrial cancer, and also supports the FIGO staging modifications made in 2009; that is, the incidence of lymph node metastases was similar for stages IA and IB (which were combined into a single stage in 2009), and IC and IIA (cervical stroma invasion became necessary for classification as stage II in 2009) [24]. The primary strength of the present study lies in its use of the SEER registry, which facilitated access to a much larger cohort of patients than would have been feasible in a prospective trial or at one institution, and Table 2 Incidence of lymph node metastases according to cancer stage and grade. "
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    ABSTRACT: Objective To determine the incidence of regional lymph node involvement for early-stage endometrial cancer by using the Surveillance, Epidemiology, and End Results (SEER) registry. Methods In a retrospective study, data were analyzed from patients who were diagnosed with stage IA–IIB endometrioid adenocarcinoma and were treated between 1998 and 2003. The incidence of pelvic and para-aortic lymph node involvement was determined. Results Data were analyzed from 4052 patients. Incidences of pelvic and para-aortic lymph node metastases were: 1% and 0% in stage IA, grade 1 disease; 2% and 0% in IA, grade 2; 2% and 1% in IA, grade 3; 2% and 0% in IB, grade 1; 3% and 1% in IB, grade 2; 3% and 2% in IB, grade 3; 7% and 3% in IC, grade 1; 8% and 5% in IC, grade 2; 12% and 8% in IC, grade 3; 7% and 3% in IIA, grade 1; 10% and 4% in IIA, grade 2; 10% and 5% in IIA, grade 3; 8% and 4% in IIB, grade 1; 13% and 8% in IIB, grade 2; and 19% and 12% in IIB, grade 3. Conclusion Incidences of pelvic and para-aortic metastases were lower than previously reported. Patients at higher stages and grades had a 10% or higher risk of lymph node involvement and might benefit from aggressive therapy.
    International Journal of Gynecology & Obstetrics 12/2014; 127(3). DOI:10.1016/j.ijgo.2014.06.022 · 1.54 Impact Factor
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