NATIONAL SURVEY OF OVARIAN CARCINOMA-VI - CRITICAL-ASSESSMENT OF CURRENT INTERNATIONAL FEDERATION OF GYNECOLOGY AND OBSTETRICS STAGING SYSTEM

Background. The Commission on Cancer of the American College of Surgeo ns recently completed a national survey of patients with ovarian cance r. From the large database, the prognostic value of current Internatio nal 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 hosp itals with cancer programs. Among a total of 12,316 cases, 5156 patien ts 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% fo r Stages I, II, III, and IV, respectively. Pairwise survival compariso ns using Lee-Desu statistic confirmed the prognostic value of current staging system (P < 0.00001). When survival data was substratified fur ther 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. Howe ver, the survival reduction is relatively small between IB-IC and IIB- IIC divisions. Survival comparisons revealed significant prognostic va lue for most substage divisions (P = 0.03-0.0002) except for IB-IC and IIB-IIC combinations (P > 0.33). Further analyses revealed no signifi cant differences between IB-IC and IIB-IIC patients in several prognos tic parameters such as age, histologic grade, cell type, and amount of residual disease. Conclusions. These data support the current FIGO st aging system. However, Substages IB-IC and IIB-IIC should be combined to respective single substages.