An Analysis of Prognostic Significance of New FIGO Staging (1989) of Endometrial Cancer

Histopathologic factors were investigated in the data for ninety-one patients with endometrial carcinoma who were treated surgically. Each of these subjects was reclassified according to the new FIGO surgical criteria (1989) for stages and the relationship between the new classifications and the prognosis of patients was analyzed. One third of the patients (24/72) with clinical FIGO stage I (1983) had extracorporeal spread of the disease and these cases were reclassified as surgical stages II and III. Among clinical stage Ib patients there were many more with extracorporeal spread than among those in clinical stage Ia (p<0.005) although there was no difference between the histopathological characteristics (histologic grade, myometrial invasion, cervical involvement, adnexal involvement and pelvic lymph node metastasis) of the stage Ia and Ib groups. Univariate survival analysis revealed that the histologic grade (p<0.05), myometrial invasion (p<0.05), cervical involvement (p<0.005) and pelvic lymph node metastasis (p<0.005) correlated with the patient's prognosis. Multivariate survival analysis with the proportional hazard regression model showed that cervical involvement (p=0.05) and the new stage classification (p=0.03) correlated significantly with the prognosis. The cumulative 5-year survival rate by clinical stage (1983) was 87% for stage I (Ia : 96%, Ib : 80%) and 72% for stage II, between which no significant difference was determined. The survival rate for stage III was not calculated because there was only one case with stage III disease in this study. On the other hand, the cumulative 5-year survival rate by surgical stage (1989) was 98% for stage I, 67% for stage II and 67% for stage III. There was found to be a significant difference between stages I and II (p<0.001), and between stages I and III (p<0.001), respectively. These results suggested that there were a number of cases with extracorporeal spread in stage I according to the clinical classifying system currently used (FIGO 1983). This was thought to be related to the relatively low rate of survival of stage I patients, and the surgical staging system seems to correlate more closely with the patient's prognosis so that the adoption of a new classifying system for this country should be considered.