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Revised FIGO staging for carcinoma of the vulva
Author(s) -
Hacker Neville F.
Publication year - 2009
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2009.02.011
Subject(s) - hacker , medicine , gynecologic oncology , citation , gynecology , obstetrics and gynaecology , vulva , library science , general surgery , surgery , pregnancy , computer science , biology , genetics , operating system
Staging of cancer is designed to allow valid comparison of results between centers, and to divide patients into prognostic groups. Ideally, the survival for the 4 major FIGO stages should be reasonably evenly spread between 0% and 100%. With the FIGO clinical staging system for vulvar cancer, there was a reasonable distribution of prognostic groups, 5-year survivals being 90.4%, 77.1%, 51.3% and 18.0% for Stages I, II, III, and IV, respectively [1]. This distribution reflected the fact that the incidence of lymph node metastases increasedwith each stage, being 10.7% for Stage I, 26.2% for Stage II, 64.2% for Stage III, and 88.9% for Stage IV [1]. In 1988, the FIGO Committee on Gynecologic Oncology adopted a surgical staging system for vulvar cancer. This change from clinical to surgical staging was logical. Vulvar cancer is usually treated surgically, the status of the regional lymph nodes is the single most important prognostic factor [2–4], and the clinical evaluation of the lymph node status is unreliable [5,6]. In 1991, the Gynecologic Oncology Group (GOG) reported a survival analysis of 588 patients who were available on their database for retrospective staging according to the new system [2]. The 5-year survival was 98% for 154 patients with Stage I disease, 85% for 231 patients with Stage II disease, 74% for 141 patients with Stage III disease, and 31% for 62 patients with Stage IV disease. It became immediately apparent that the first problem with the new staging was that it did not give a good spread of prognostic groupings. The GOG reported that when tumors had negative lymph nodes, even primary lesions up to 8 cm diameter were low risk. Some unpublished Surveillance, Epidemiology, and End Results (SEER) data have confirmed this. For 349 patients with a primary lesion greater than 8 cm diameter and negative nodes seen between 1988 and 2001, the 5-year survival was 88% [7]. We have recently reviewed our own data on 121 patients with FIGO Stages I and II vulvar cancer, and demonstrated no difference in survival between these two stages [8]. A second problemwith the 1988 surgical staging, identified by the GOG analysis, was that Stage III represented a heterogeneous group of patients prognostically, with survivals ranging from 100% to 34%. For example, there were 6 patients with tumors 2 cm or less involving the vagina and/or urethra, with negative nodes, and their survival was 100%. There were 47 patients who had a tumor less than 2 cm in diameter with 1 positive node, and they had a survival of 95%. On the other hand, therewere 28 patients who had a tumor greater than 8 cm