The revised 2014 FIGO staging system for epithelial ovarian cancer: is a subclassification of FIGO stage IV justified?

ObjectiveThe revised version of the International Federation of Gynaecology and Obstetrics (FIGO) staging system (2014) for epithelial ovarian cancer includes a number of changes. One of these is the division of stage IV into 2 subgroups. Data on the prognostic and predictive significance of this classification are scarce. The effect of neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) in relation to the subclassification of FIGO stage IV is also unknown.MethodsWe used data of the EORTC 55971 trial, in which 670 patients with previous stage IIIC or IV epithelial ovarian cancer were randomly assigned to PDS or NACT; 160 patients had previous stage IV. Information on previous FIGO staging and presence of pleural effusion with positive cytology were used to classify tumors as either stage IVA or IVB. We tested the association between stage IVA/IVB and survival to evaluate the prognostic value and interactions between stage, treatment, and survival to evaluate the predictive performance.ResultsAmong the 160 participants with previous stage IV disease, 103 (64%) were categorized as stage IVA and 57 (36%) as stage IVB tumors. Median overall survival was 24 months in FIGO stage IVA and 31 months in stage IVB patients (P = 0.044). Stage IVB patients treated with NACT had 9 months longer median overall survival compared with IVB patients undergoing PDS (P = 0.025), whereas in IVA patients, no significant difference was observed (24 vs 26 months, P = 0.48).ConclusionsThe reclassification of FIGO stage IV into stage IVA or IVB was not prognostic as expected. Compared with stage IVA patients, stage IVB patients have a better overall survival and may benefit more from NACT.

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2743 The revised 2014 FIGO staging system for epithelial ovarian cancer: Is a subclassification of stage IV justified?

European Journal of Cancer ◽

10.1016/s0959-8049(16)31509-x ◽

2015 ◽

Vol 51 ◽

pp. S544

Author(s):

B. Ataseven ◽

P. Harter ◽

F. Heitz ◽

A. Traut ◽

S. Prader ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage Iv ◽

Staging System ◽

Figo Staging

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The revised 2014 FIGO staging system for epithelial ovarian cancer: Is a subclassification into FIGO stage IVA and IVB justified?

Gynecologic Oncology ◽

10.1016/j.ygyno.2016.05.021 ◽

2016 ◽

Vol 142 (2) ◽

pp. 243-247 ◽

Cited By ~ 10

Author(s):

Beyhan Ataseven ◽

Philipp Harter ◽

Christoph Grimm ◽

Florian Heitz ◽

Sebastian Heikaus ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Staging System ◽

Figo Stage ◽

Figo Staging

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A Practical Nomogram to Predict Early Death in Advanced Epithelial Ovarian Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.655826 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zixuan Song ◽

Yangzi Zhou ◽

Xue Bai ◽

Dandan Zhang

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage Iv ◽

Early Death ◽

Premature Death ◽

Figo Stage ◽

Stage Iii ◽

Internal Validation ◽

Gynecological Malignancy ◽

Clinical Pragmatism

Background: Ovarian cancer is a common gynecological malignancy, most of which is epithelial ovarian cancer (EOC). Advanced EOC is linked with a higher incidence of premature death. To date, no effective prognostic tools are available to evaluate the possibility of early death in patients with advanced EOC.Methods: Advanced (FIGO stage III and IV) EOC patients who were enrolled in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were regarded as subjects and studied. We aimed to construct a nomogram that can deliver early death prognosis in patients with advanced EOC by identifying crucial independent factors using univariate and multivariate logistic regression analyses to help deliver accurate prognoses.Results: In total, 13,403 patients with advanced EOC were included in this study. Three hundred ninety-seven out of a total of 9,379 FIGO stage III patients died early. There were 4,024 patients with FIGO stage IV, 414 of whom died early. Nomograms based on independent prognostic factors have the satisfactory predictive capability and clinical pragmatism. The internal validation feature of the nomogram demonstrated a high level of accuracy of the predicted death.Conclusions: By analyzing data from a large cohort, a clinically convenient nomogram was established to predict premature death in advanced EOC. This tool can aid clinicians in screening patients who are at higher risk for tailoring treatment plans.

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Combined score of pretreatment platelet count and CA125 level (PLT-CA125) stratified prognosis in patients with FIGO stage IV epithelial ovarian cancer

Journal of Ovarian Research ◽

10.1186/s13048-019-0544-y ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 4

Author(s):

Jie-Ping Chen ◽

Qi-Dan Huang ◽

Ting Wan ◽

Hua Tu ◽

Hai-Feng Gu ◽

...

Keyword(s):

Ovarian Cancer ◽

Platelet Count ◽

Epithelial Ovarian Cancer ◽

Stage Iv ◽

Figo Stage ◽

Ca125 Level

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Development and validation of a nomogram to predict survival outcome among epithelial ovarian cancer patients with site-distant metastases: a population-based study

BMC Cancer ◽

10.1186/s12885-021-07977-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bo Wang ◽

Shixuan Wang ◽

Wu Ren

Keyword(s):

Ovarian Cancer ◽

Prognostic Factors ◽

Bone Metastasis ◽

Epithelial Ovarian Cancer ◽

Lung Metastasis ◽

Lymphatic Metastasis ◽

Staging System ◽

Distant Metastases ◽

Figo Staging ◽

Staging Surgery

Abstract Background Increasing evidence indicates that site-distant metastases are associated with survival outcomes in patients with epithelial ovarian cancer. This study aimed to investigate the prognostic values of site-distant metastases and clinical factors and develop a prognostic nomogram score individually predicting overall survival (OS, equivalent to all-cause mortality) and cancer specific survival (CSS, equivalent to cancer-specific mortality) in patients with epithelial ovarian cancer. Methods We retrospectively collected data on patients with epithelial ovarian cancer from the Surveillance, Epidemiology, and End Results (SEER) database between 1975 and 2016. Multivariate Cox regression was performed to identify survival trajectories. A nomogram score was used to predict long-term survival probability. A comparison between the nomogram and the International Federation of Gynecology and Obstetrics (FIGO 2018) staging system was conducted using time-dependent receiver operating characteristic (tROC) curve. Results A total of 131,050 patients were included, 18.2, 7.8 and 66.1% had localized, regional and distant metastases, respectively. Multivariate analysis identified several prognostic factors for OS including race, grade, histology, FIGO staging, surgery, bone metastasis, liver metastasis, lung metastasis, and lymphatic metastasis. Prognostic factors for CSS included grade, site, FIGO staging, surgery, bone metastasis, brain metastasis, lung metastasis, lymphatic metastasis, and insurance. Following bootstrap correction, the C-index of OS and CSS was 0.791 and 0.752, respectively. These nomograms showed superior performance compared with the FIGO 2018 staging criteria (P < 0.05). Conclusions A novel prognostic nomogram score provides better prognostic performance than the FIGO 2018 staging system. These nomograms contribute to directing clinical treatment and prognosis assessment in patients harboring site-distant metastases.

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Prognostic impact of debulking surgery and residual tumor in patients with epithelial ovarian cancer FIGO stage IV

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.12.007 ◽

2016 ◽

Vol 140 (2) ◽

pp. 215-220 ◽

Cited By ~ 31

Author(s):

Beyhan Ataseven ◽

Christoph Grimm ◽

Philipp Harter ◽

Florian Heitz ◽

Alexander Traut ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage Iv ◽

Residual Tumor ◽

Figo Stage ◽

Prognostic Impact ◽

Debulking Surgery

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Association between Expression of CD133 and Aldehyde Dehydrogenase 1A1 (ALDH1A1) with FIGO Stage in Serous Ovarian Cancer

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v6i5.04 ◽

2019 ◽

Vol 6 (05) ◽

pp. 4449-4454

Author(s):

Desi Puspita ◽

Hasrayati Agustina ◽

Birgitta Maria Dewayani ◽

Bethy Surjawathy Hernowo ◽

Sri Suryanti

Keyword(s):

Ovarian Cancer ◽

Early Stage ◽

Staging System ◽

Figo Stage ◽

P Value ◽

Serous Ovarian Cancer ◽

Prognostic Information ◽

Chi Square ◽

Cross Sectional ◽

Figo Staging

Ovarian cancer (OC) is the fifth most common cancer in women and has become the main cause of gynecologic malignancy death. The incidence rate of OC increase and overall survival (OS) is relatively low because most of patients are diagnosed at advanced stages. Serous ovarian cancer (SOC) is the most frequent histopathological type and often occurs at late stage. Stage and optimal treatment are independently associated with chemo-response in SOC. FIGO staging system in SOC can provide prognostic information and guidance on personalized management of ovarian cancer. Cancer stem cells (CSC) are pivotal players in SOC progression and prognosis. CD133 and ALDH1A1 are related CSC markers in SOC. This study aimed to investigate the expression of CD133 and ALDH1A1 in SOC and their correlation with FIGO stage. This research was carried out as analytic-observational with cross-sectional design using paraffin block of patients diagnosed with SOC in the Department of Anatomic Pathology Hasan Sadikin Hospital Bandung. Samples were divided in two groups: early stage (FIGO stage I and II) and advanced stage (FIGO stage III and IV). All samples were stained by immunohistochemistry CD133 and ALDH1A1. All data were analysed using Chi-Square test with significant level 5%. The results of this study showed that there was correlation between expression of CD133 with FIGO staging in SOC (p value 0.004) and there was no correlation between expression of ALDH1A1 with FIGO staging in SOC (p value 0.197). It can be concluded that higher CD133 expression showed higher tumour cells ability to do invasion and metastasis and had higher influenced FIGO stage.

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International Federation of Gynecology and Obstetrics Staging Classification for Cancer of the Ovary, Fallopian Tube, and Peritoneum: Estimation of Survival in Patients With Node-Positive Epithelial Ovarian Cancer

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000316 ◽

2015 ◽

Vol 25 (1) ◽

pp. 49-54 ◽

Cited By ~ 21

Author(s):

Augusto Pereira ◽

Tirso Pérez-Medina ◽

Javier F. Magrina ◽

Paul M. Magtibay ◽

Ana Rodríguez-Tapia ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Staging System ◽

Peritoneal Metastases ◽

International Federation ◽

Anatomical Location ◽

Abdominal Lymph Node ◽

Node Positive ◽

Figo Staging ◽

Gynecology And Obstetrics

ObjectiveThe objective of this study was to determine the survival of patients with node-positive epithelial ovarian cancer according to the 2014 International Federation of Gynecology and Obstetrics (FIGO) staging system.Materials and MethodsWe performed a retrospective chart review. Data from all consecutive patients with node-positive epithelial ovarian cancer (stages IIIC and IV) who underwent cytoreductive surgery at the Mayo Clinic from 1996 to 2000 were reassessed to evaluate the prognostic significance of the new FIGO stages. Multivariate Cox regression was performed, and Kaplan-Meier survival curves constructed.ResultsThe distribution of the restaged patients was as follows: IIIA1, 23 patients (IIIA1i, 9 patients; and IIIA1ii, 14 patients); IIIA2, 3 patients; IIIB, 4; IIIC, 67 patients; IVA, 4 patients; and IVB, 15 patients. In the univariate analysis, the relative risk for positive nodes greater than 10 mm on the longer axis was 2.57 and 3.00 for patients with microscopic peritoneal disease, compared with patients with microscopic positive nodes. However, the difference was not statistically significant. Moreover, the univariate analyses revealed statistically significant differences for 2014 FIGO stages (IIIA, IIIB, IIIC, and IVA-B), anatomical sites of peritoneal metastases, and disease staged at IIIC because of the presence of omental metastases. Multivariate analysis showed that survival was higher in patients restaged to IIIA-B than in those restaged to IIIC and IV (hazard ratios, 2.75 and 3.16, respectively; P = 0.002). The hazard ratio for patients with abdominal peritoneal metastases was 2.76 compared with patients with pelvic peritoneal metastases (P = 0.001).ConclusionsThe current 2014 FIGO staging system for ovarian cancer successfully correlates survival, anatomical location of peritoneal metastases, and extra-abdominal lymph node metastases.

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