子宫内膜癌与新的FIGO分期精选.pptVIP

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子宫内膜癌与新的FIGO分期精选.ppt

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子宫内膜癌与新的FIGO分期精选

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * None Inner 1/3 myo Middle 1/3 myo Outer 1/3 myo Morrow et al. GOG, 1991 Endometrial Carcinoma 1.0% 7.7% 14.5% 15.0% Recurrence Depth of myo inv * FIGO II * Corpus Cancer Staging (FIGO 1988) Stage Characteristics IA G123 Tumor limited to endometrium IB G123 Invasion to 1/2 myometrium IC G123 Invasion to 1/2 myometrium IIA Endocervical glandular involvement only IIB Cervical stromal invasion IIIA Tumor invades serosa and/or adnexae and/or positive peritoneal cytology IIIB Vaginal involvement or metastasis IIIC Metastasis to pelvic and/or para-aortic lymph nodes IVA Tumor invasion of bladder and/or bowel mucosa IVB Distant metastasis including intra-abdominal and/or inguinal lymph nodes FIGO Announcements: Stages-1988 Revision. Gynecol Oncol 1989, 35:125 * Stage IIB * * * Problems of Stage II Corpus Cancer Diagnostic reproducibility probably low (never tested) How does it involve glands only? FIGO never defines how to make the diagnosis of glandular or mucosa involvement only Pathologists make the diagnosis with their own experience Often no stromal response in low grade cancer * Stage II Corpus CancerSignificance of true surgical pathologic staging: a GOG study (Creasman et al, 1999) 148/1180 with clinical stage II (+ECC) 66/148 with cervical involvement 31/66 with extrauterine disease 35 (24%) with surgical stage II Recurrence rates at 5 years: IIA – 18% IIB – 21% * Stage II Corpus Cancer 5 year survival - 75%, lower than Stage I (FIGO results, 2003) More often associated with higher grade, deep myometrial invasion, and lymphatic invasion than Stage I Insufficient data to determine whether Stage II is a significant prognosticator by multivariate analysis (probably not) In most studies, stage IIA has the same prognosis as stage 1 tumors. Zaino R, 2008 * FIGO IIIA * Corpus Cancer Staging (FIGO 19