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:
Key Basic Research and Development Program Foundation of China (973 Program) [2015CB553903, 2009CB521806]; National High Technology and Development Program of China (863 Program)National High Technology Research and Development Program of China [2012AA02A507]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [91529102, 81572571, 81402160, 81302267, 81230038, 81090414, 81101964, 81472444, 81272422, 81172464, 81572725]
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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推荐引用方式(GB/T 7714):
li shuang,li xiong,zhang yuan,et al.Development and validation of a surgical-pathologic staging and scoring system for cervical cancer[J].ONCOTARGET.2016,7(15):21054-21063.doi:10.18632/oncotarget.8245.
APA:
li,shuang,li,xiong,zhang,yuan,zhou,hang,tang,fangxu...&ma,ding.(2016).Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.ONCOTARGET,7,(15)
MLA:
li,shuang,et al."Development and validation of a surgical-pathologic staging and scoring system for cervical cancer".ONCOTARGET 7..15(2016):21054-21063