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. 2020 Jul;31(4):e45.
doi: 10.3802/jgo.2020.31.e45. Epub 2020 Jan 13.

A retrospective study for investigating the relationship between old and new staging systems with prognosis in ovarian cancer using gynecologic cancer registry of Japan Society of Obstetrics and Gynecology (JSOG): disparity between serous carcinoma and clear cell carcinoma

Wataru Yamagami  1 , Satoru Nagase  2 , Fumiaki Takahashi  3 , Kazuhiko Ino  4 , Toru Hachisuga  5 , Mikio Mikami  6 , Takayuki Enomoto  7 , Hidetaka Katabuchi  8 , Daisuke Aoki  9
Affiliations

A retrospective study for investigating the relationship between old and new staging systems with prognosis in ovarian cancer using gynecologic cancer registry of Japan Society of Obstetrics and Gynecology (JSOG): disparity between serous carcinoma and clear cell carcinoma

Wataru Yamagami et al. J Gynecol Oncol. 2020 Jul.

Abstract

Objective: International Federation of Gynecology and Obstetrics (FIGO) staging for ovarian, fallopian tube, and peritoneal cancers was revised in 2014. The aim of this study is to clarify whether the revised FIGO2014 staging reflects the prognosis of patients with ovarian cancer by histological type in Japan.

Methods: We extracted 9,747 patients who were diagnosed with ovarian cancer since 2004 until 2008 and who could be classified into appropriate stages from the Gynecologic Cancer Registry of Japan Society of Obstetrics and Gynecology. These cases were analyzed after revision to FIGO2014 based on the pTNM classification.

Results: Among stage I, the 5-year overall survival rate (5y-OS) in FIGO2014 was 94.9% in stage IA, 92.3% in stage IC1, 86.1% in IC2, and 84.9% in IC3 with significant differences between stages IA and IC1 (p=0.012), IC1 and IC2 (p<0.001). There was a significant difference between stages IA and IC1 in clear cell and mucinous carcinoma but not in serous and endometrioid carcinoma. Among stage III, the 5y-OS was 75.6% in stage IIIA1, 68.9% in IIIA2, 58.6% in IIIB, and 44.4% in IIIC, with significant differences between stages IIIA2 and IIIB (p=0.009), IIIB and IIIC (p<0.001). Among stage IV, the 5y-OS was 43.1% in stage IVA* and 32.1% in IVB with a significant difference (p=0.002).

Conclusion: The results suggest that changes in classification for stage III and stage IV are appropriate, but the subclassification for stage IC might be too detailed. There was a discrepancy of prognosis by histological type between stage IA and IC1.

Keywords: Cancer Staging; Clear Cell Carcinoma; Ovarian Cancer; Prognosis; Serous Carcinoma.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Re-classification of ovarian cancer post-surgical staging from FIGO1988 to FIGO2014. Of the 317 cases in stage IIIc (FIGO1988), 11 cases were reclassified into stage IA, 28 into stage IC, 2 into stage IIA, 3 into stage IIB, 18 into stage unclassified II, 218 into stage IIIA and 37 into stage IIIB (FIGO2014), respectively. Of the 872 cases in stage IV (FIGO1988) 184 cases were classified into stage IVA and 688 in stage IVB (FIGO2014), respectively.
FIGO, International Federation of Gynecology and Obstetrics.
Fig. 2
Fig. 2. OS in patients with stage I to IV ovarian cancer. (A) FIGO1988 staging system, (B) FIGO2014 staging system. 5y-OS in FIGO2014 were similar to that in FIGO1988 staging system. There were significant differences between all stages in FIGO1988 and FIGO2014.
5y-OS, 5-year overall survival rate; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival.
Fig. 3
Fig. 3. OS in patients with stage IA and IC ovarian cancer. (A) FIGO1988 staging system. There were significant differences of 5y-OS between stage Ia and Ic(b), or Ic(b) and Ic(a). There was no significant difference between stage Ic(a) and Ic(1), or Ic(1) and Ic(2). (B) FIGO2014 staging system. There were significant differences of 5y-OS between stage IA and IC1, or IC1 and IC2. There was no significant difference between stage IC2 and IC3.
5y-OS, 5-year overall survival rate; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival.
Fig. 4
Fig. 4. OS in patients with stage III ovarian cancer. (A) FIGO1988 staging system. There were significant differences of 5y-OS between IIIa and IIIb, or IIIb and IIIc. (B) FIGO2014 staging system. There were significant differences of 5y-OS between IIIA2 and IIIB, or IIIB and IIIC. There was no significant difference between IIIA1 and IIIA2.
5y-OS, 5-year overall survival rate; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival.
Fig. 5
Fig. 5. OS in patients with stage IV ovarian cancer. 5y-OS of stage IVB were significantly poorer than that of stage IVA* in FIGO 2014 staging system for ovarian cancer.
5y-OS, 5-year overall survival rate; FIGO, International Federation of Gynecology and Obstetrics; OS, overall survival.
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