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Development and validation of a surgical-pathologic staging and scoring system for cervical cancer

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单位: [1]Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Dept Obstet & Gynecol, Wuhan 430074, Peoples R China [2]Cent Hosp Wuhan, Dept Gynecol & Obstet, Wuhan, Peoples R China [3]Huazhong Univ Sci & Technol, Dept Obstet & Gynecol, Union Hosp, Tongji Med Coll, Wuhan 430074, Peoples R China [4]Hunan Prov Tumor Hosp, Dept Gynecol Oncol, Changsha, Hunan, Peoples R China [5]Womens Reprod Hlth Lab Zhejiang Prov, Hangzhou, Zhejiang, Peoples R China [6]Shandong Univ, Qilu Hosp, Dept Gynecol & Obstet, Jinan, Shandong, Peoples R China [7]Xi An Jiao Tong Univ, Affiliated Hosp 1, Sch Med, Dept Obstet & Gynecol, Xian 710049, Peoples R China [8]Sun Yat Sen Univ, Affiliated Hosp 2, Dept Gynecol Oncol, Guangzhou 510275, Guangdong, Peoples R China [9]Huazhong Univ Sci & Technol, Xiangfan Cent Hosp, Dept Obstet & Gynecol, Tongji Med Coll, Xiangfan, Hubei, Peoples R China [10]Tianjin Cent Hosp Gynecol & Obstet, Tianjin, Peoples R China [11]Wuhan Univ, Zhong Nan Hosp, Dept Gynecol Oncol, Wuhan 430072, Peoples R China [12]Commercial Vocat Hosp, Wuhan, Peoples R China [13]Henan Univ Sci & Technol, Dept Obstet & Gynecol, Affiliated Hosp 1, Luoyang, Henan, Peoples R China
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关键词: cervical cancer risk factor FIGO stage surgical-pathologic stage SPSs

摘要:
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.

基金:

基金编号: 2015CB553903 2009CB521806 2012AA02A507 91529102 81572571 81402160 81302267 81230038 81090414 81101964 81472444 81272422 81172464 81572725

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出版当年[2015]版:
大类 | 1 区 医学
小类 | 2 区 肿瘤学 3 区 细胞生物学
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Q1 ONCOLOGY Q1 CELL BIOLOGY
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第一作者单位: [1]Huazhong Univ Sci & Technol, Tongji Med Coll, Tongji Hosp, Dept Obstet & Gynecol, Wuhan 430074, Peoples R China
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