Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.
Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.
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宫颈癌手术病理分期和评分系统的开发和验证
DOI：
10.18632/oncotarget.8245
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发表时间：
2016-04-12
期刊：
影响因子：
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通讯作者：
Ma D
中科院分区：
文献类型：
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作者：
Li S;Li X;Zhang Y;Zhou H;Tang F;Jia Y;Hu T;Sun H;Yang R;Chen Y;Cheng X;Lv W;Wu L;Zhou J;Wang S;Huang K;Wang L;Yao Y;Yang Q;Yang X;Zhang Q;Han X;Lin Z;Xing H;Qu P;Cai H;Song X;Tian X;Shen J;Xi L;Li K;Deng D;Wang H;Wang C;Wu M;Zhu T;Chen G;Gao Q;Wang S;Hu J;Kong B;Xie X;Ma D
背景全世界大多数宫颈癌患者接受手术治疗，但目前的国际妇产科联合会（FIGO）分期系统不考虑病理学资料。我们提出了一个更全面和更有临床价值的肿瘤病理分期和评分系统（SPS）。方法对4，220例符合条件的宫颈癌病例（队列1）的记录进行手术病理风险因素筛查。我们构建了一个病理学分期和SPS，随后在1,104例宫颈癌患者（队列2）的前瞻性研究中进行了验证。结果在队列1中，7个独立的危险因素与患者预后相关：淋巴结转移（LNM），宫旁受累，组织学类型，分级，肿瘤大小，间质浸润和淋巴管间隙浸润（LVSI）。FIGO分期系统被修订并扩展为一个肿瘤病理分期系统，包括LNM、间质浸润和LVSI的额外标准。LNM根据转移灶的数量和位置分为三类。纳入所有七个预后风险因素提高了实际适用性。将患者分为3个SPS风险类别：0分、低分和高分，评分为0、1 - 3和≥4（P=1.08E-45; P=6.15E-55）。在队列2中，5年总生存期（OS）和无病生存期（DFS）结局随SPS评分增加而降低（P=9.04E-15; P=3.23E-16），验证了该方法。手术病理分期和SPS显示出比FIGO分期更大的同质性和区分效用。结论手术-病理分期和SPS可提高对肿瘤严重程度和侵袭性的判断，更准确地预测预后，指导术后治疗。
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.