Impact of the new FIGO 2013 classification on prognosis of stage I epithelial ovarian cancers

Figures & data

Table 1 Details of the FIGO classification for ovarian and fallopian tube(s) cancers: old 1988 vs new 2013 FIGO staging

		Old – 1988 FIGO stage		New – 2013 FIGO stage
Stage I	IA	Tumor limited to one ovary, capsule intact, no tumor on ovarian surface, and negative washings/ascites	IA	Tumor limited to one ovary or fallopian tube, capsule intact, no tumor on surface, and negative washings/ascites
	IB	Tumor involves both ovaries, capsule intact, no tumor on ovarian surface, and negative washings/ascites	IB	Tumor limited to both ovaries or fallopian tubes, capsule intact, no tumor on surface, and negative washings/ascites
	IC	Tumor limited to ovaries with any of the following: capsule rupture, tumor on ovarian surface, or positive washing/ascites	IC	Tumor limited to one or both ovaries or fallopian tube
			IC1	• With surgical spill
			IC2	• With capsule rupture before surgery or tumor on ovarian or fallopian tube surface
			IC3	• With malignant cells in the ascites or peritoneal washings

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Table 2 Patient characteristics

Baseline characteristics	All	IA	IB	IC1	IC2	IC3	P-value	N
	n=128	n=71	n=2	n=14	n=11	n=30
Primary site							0.071	128
• Ovary	124 (96.9%)	71(100%)	2 (100%)	13 (92.9%)	10 (90.9%)	28 (93.3%)
• Fallopian tube	4 (3.12%)	0	0	1 (7.14%)	1 (9.09%)	2 (6.67%)
Histology							0.300	128
• Serous	36 (28.1%)	14 (19.7%)	1 (50.0%)	3 (21.4%)	4 (36.4%)	14 (46.7%)
• Clear cell	16 (12.5%)	13 (18.3%)	0	1 (7.14%)	0	2 (6.67%)
• Endometrioid	33 (25.8%)	18 (25.4%)	1 (50.0%)	6 (42.9%)	3 (27.3%)	5 (16.7%)
• Mucinous	32 (25.0%)	22 (31.0%)	0	4 (28.6%)	2 (18.2%)	4 (13.3%)
• Transitional	2 (1.56%)	1 (1.41%)	0	0	0	1 (3.33%)
• MMMT, mixed	9 (6.98%)	3 (4.17%)	0	0	2 (18.2%)	4 (13.33%)
Gradea							0.011	103
• G1	37 (35.9%)	27 (49.1%)	0	5 (45.5%)	2 (22.2%)	3 (11.1%)
• G2	26 (25.2%)	14 (25.5%)	0	2 (18.2%)	3 (33.3%)	7 (25.9%)
• G3	40 (38.8%)	14 (25.5%)	1 (100%)	4 (36.4%)	4 (44.4%)	17 (63.0%)
• Missing	25
Staginga							0.426	116
• Complete	72 (62.1%)	39 (60.9%	0	8 (57.1%)	6 (66.7%)	19 (70.4%)
• Incomplete	44 (37.9%)	25 (39.1%)	2 (100%)	6 (42.9%)	3 (33.3%)	8 (29.6%)
• Missing	12
Chemotherapya							>0.001	102
• No	46 (45.1%)	38 (69.1%)	0	2 (18.2%)	2 (22.2%)	4 (15.4%)
• Yes	56 (54.9%)	17 (30.9%)	1 (100%)	9 (81.8%)	7 (77.8%)	22 (84.6%)
• Missing	26
Follow-up months, median (IQR)	37.0 [12.5; 92.5]	35.0 [12.0; 111]	19.0 [19.0; 19.0]	35.5 [12.5; 66.5]	60.0 [36.0; 92.5]	27.0 [13.0; 68.2]	0.803	123
Missing	5
Age, years	56.0 [45.0; 68.0]	60.0 [47.5; 67.5]	67.0 [57.5; 76.5]	46.5 [41.5; 56.0]	59.0 [42.0; 69.5]	55.0 [45.5; 68.8]	0.206	128

Notes:

a Percentages calculated excluding missing values from denominator. N, number available for each variable; Missing, information on patient was missing; Chemotherapy, adjuvant platinum-based chemotherapy.

Abbreviations: IQR, interquartile range; MMMT, malignant mixed Mullerian tumor or carcinosarcoma; n, number.

Table 3 Patients with recurrence and FIGO I stage disease

Baseline characteristics	Recurrence
	n=20
Primary site
• Ovary	19 (95%)
• Fallopian tube	1 (5%)
Histology
• Serous	6 (30.0%)
• Clear cell	2 (10.0%)
• Endometrioid	6 (30.0%)
• Mucinous	2 (10.0%)
• Transitional	0
• MMMT, mixed	4 (20.0%)
FIGO stage
• IA	8 (40.0%)
• IB	0
• IC1	2 (10.0%)
• IC2	3 (15.0%)
• IC3	7 (35.0%)
Gradea
• G1	4 (25.0%)
• G2	5 (31.2%)
• G3	7 (43.8%)
• Missing	4
Staginga
• Complete	10 (66.7%)
• Incomplete	5 (33.3%)
• Missing	5
Chemotherapya
• No	3 (20.0%)
• Yes	12 (80.0%)
• Missing	5
Follow-up months, median (IQR)	46.0 [7.00; 174]
Age, years	61.0 [23.0; 85.0]

Notes:

a Percentages calculated excluding missing values from denominator. Missing, information on patient was missing; Chemotherapy, adjuvant platinum-based chemotherapy.

Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; IQR, interquartile range; MMMT, malignant mixed Mullerian tumor or carcinosarcoma; n, number.

Table 4 Subgroups comparison reported as HR adjusted for chemotherapy, with lower and upper 95% confidence limits

Comparison	HR	LCL	UCL	P-value
IA vs IC1	1.83	0.19	18.02	0.604
IA vs IC2	0.98	0.17	5.65	0.981
IA vs IC3	0.56	0.14	2.18	0.404
IC1 vs IC2	0.53	0.05	5.96	0.611
IC1 vs IC3	0.31	0.04	2.52	0.273
IC2 vs IC3	0.57	0.12	2.8	0.492

Abbreviations: LCL, lower confidence limit; UCL, upper confidence limit.

Figure 1 Relapse-free survival using the old FIGO classification system for the cohort of 128 patients with ovarian and tubal cancers in FIGO I stage.

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Figure 2 Relapse-free survival using the new FIGO classification system for the cohort of 128 patients with ovarian and tubal cancers in FIGO I stage.

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Figure 3 Disease-specific survival using the old FIGO classification system for the cohort of 128 patients with ovarian and tubal cancers in FIGO I stage.

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Figure 4 Disease-specific survival using the new FIGO classification system for the cohort of 128 patients with ovarian and tubal cancers in FIGO I stage.

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.