National survey of ovarian carcinoma VI: Critical assessment of Current International Federation of Gynecology and Obstetrics Staging System

• Published in: Cancer 1993-11, Vol.72 (10), p.3007-3011
• Main Authors: Nguyen, Hoa N., Averette, Hervy E., Hoskins, William, Sevin, Bernd‐Uwe, Penalver, Manuel, Steren, Albert
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Gynecology; Health Surveys; Humans; International Federation of Gynecology and Obstetrics staging; Middle Aged; national survey; Neoplasm Staging - methods; Obstetrics; ovarian carcinoma; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Prognosis; Societies, Medical; substage division; Survival Rate; United States
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19931115)72:10<3007::AID-CNCR2820721024>3.0.CO;2-N

Background. The Commission on Cancer of the American College of Surgeons recently completed a national survey of patients with ovarian cancer. From the large database, the prognostic value of current International Federation of Gynecology and Obstetrics (FIGO) staging system for ovarian carcinoma was re‐examined. Methods. Data was collected from 25 consecutive ovarian carcinomas diagnosed in 1983 and 1988 at 904 hospitals with cancer programs. Among a total of 12,316 cases, 5156 patients had long‐term survival data. Results. The overall 5‐year survivals were 88.9 ± 0.9%; 57.1 ± 2.4%; 23.8 ± 1.3%; and 11.6 ± 0.9% for Stages I, II, III, and IV, respectively. Pairwise survival comparisons using Lee–Desu statistic confirmed the prognostic value of current staging system (P < 0.00001). When survival data was substratified further to substage division, the 5‐year survivals were: IA, 92.1 ± 0.9%; IB, 84.9 ± 3.4%; IC, 82.4 ± 2.0%; IIA, 69.0 ± 4.3%; IIB, 56.4 ± 3.6%; IIC, 51.4 ± 4.5%; IIIA, 39.3 ± 2.8%; IIIB, 25.5 ± 2.6%; IIIC, 17.1 ± 1.4%; and IV, 11.6 ± 0.9%. As the disease process becomes more advanced, patients' survival reduces proportionally. However, the survival reduction is relatively small between IB‐IC and IIB‐IIC divisions. Survival comparisons revealed significant prognostic value for most substage divisions (P = 0.03‐0.0002) except for IB–IC and IIB–IIC combinations (P > 0.33). Further analyses revealed no significant differences between IB–IC and IIB–IIC patients in several prognostic parameters such as age, histologic grade, cell type, and amount of residual disease. Conclusions. These data support the current FIGO staging system. However, Substages IB–IC and IIB–IIC should be combined to respective single substages.