title: National survey of ovarian carcinoma. VI. Critical assessment of current International Federation of Gynecology and Obstetrics staging system.
abstract: BACKGROUND
  The Commission on Cancer of the American College of Surgeons recently completed a national survey of patients with ovarian cancer. From the large database, the prognostic value of current International 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 hospitals with cancer programs. Among a total of 12,316 cases, 5156 patients 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% for Stages I, II, III, and IV, respectively. Pairwise survival comparisons using Lee-Desu statistic confirmed the prognostic value of current staging system (P < 0.00001). When survival data was substratified further 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. However, the survival reduction is relatively small between IB-IC and IIB-IIC divisions. Survival comparisons revealed significant prognostic value for most substage divisions (P = 0.03-0.0002) except for IB-IC and IIB-IIC combinations (P > 0.33). Further analyses revealed no significant differences between IB-IC and IIB-IIC patients in several prognostic parameters such as age, histologic grade, cell type, and amount of residual disease.
  
  
  CONCLUSIONS
  These data support the current FIGO staging system. However, Substages IB-IC and IIB-IIC should be combined to respective single substages.
authors.affiliation: Department of Obstetrics & Gynecology, University of Miami School of Medicine, Florida 33101.
authors.forename: H N
authors.initials: HN
authors.lastname: Nguyen
authors.forename: H E
authors.initials: HE
authors.lastname: Averette
authors.forename: W
authors.initials: W
authors.lastname: Hoskins
authors.forename: B U
authors.initials: BU
authors.lastname: Sevin
authors.forename: M
authors.initials: M
authors.lastname: Penalver
authors.forename: A
authors.initials: A
authors.lastname: Steren
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006176:Gynecology; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D009774:Obstetrics; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D012955:Societies, Medical; D015996:Survival Rate; D014481:United States