Validation of The 2018 FIGO Staging System for Predicting The Prognosis of Patients With Stage IIIC Cervical Cancer

Abstract Purpose We aimed to validate the prognostic performance of the 2018 International Federation of Gynecology and Obstetrics(FIGO) IIIC staging system for patients with cervical cancer. Methods We conducted a retrospective analysis of patients with stage III cervical cancer according to the 2018 FIGO staging system who received standardized treatment from January 2011 to December 2014. Results Multivariable analysis revealed that stage IIIC1 was not significantly associated with increased risk of death compared with stages IIIA (hazard ratio [HR] = 1.432; 95% confidence interval [CI]: 0.867 to 2.366; P = 0.161) and IIIB (HR = 1.261; 95% CI: 0.871 to 1.827; P = 0.219). Stage IIIC2 was an independent indicator of increased risk of mortality compared with stages IIIA (HR = 2.958; 95% CI :1.757 to 4.983; P < 0.001) and IIIB (HR = 2.606; 95% CI: 1.752 to 3.877; P < 0.001). We stratified patients with stage IIIC1 according to T stage and compared survival outcomes. Stage IIIC1 (T1) was associated with longer 5-year overall survival (OS) compared with stages IIIA (P = 0.004) or IIIB (P < 0.001). An optimal cut-off value (= 2) was established for predicting the prognosis of stage IIIC1p(T1/T2a), which was associated with the number of pelvic lymph nodes metastases (PLNMs). Patients with stage IIIC1pN1-2 experienced longer 5-year OS compared those with stages IIIA (P = 0.01) or IIIB (P < 0.001). Conclusion Patients with stage IIIC1 cervical cancer exhibited heterogeneous clinical characteristics reflecting their variable prognoses, depending on T-stage and the extent of PLNMs