The justification for a surgical staging system in endometrial carcinoma

Three hundred and one patients with endometrial carcinoma who were surgically staged and treated postoperatively with irradiation at the Fox Chase Cancer Center or the Hospital of the University of Pennsylvania were retrospectively substaged by the 1988 FIGO staging system. For pathological stage I endometrial carcinoma, FIGO substage (IA/IB vs. IC) in addition to depth by thirds (< or = 2/3 vs. > 2/3), grade (1 or 2 vs. 3), age (< or = 60 vs. > 60), and type of postoperative irradiation (vaginal alone vs. external +/- vaginal) were predictive for 5-year cause-specific survival in univariate analysis. For all pathological stages, excluding IIIB and IV endometrial carcinoma, FIGO stage (I or II vs. III) in addition to depth by thirds (< or = 2/3 vs. > 2/3), grade (1 or 2 vs. 3), age (< or = 60 vs. > 60), and type of postoperative irradiation (vaginal alone vs. external +/- vaginal) were predictive for 5-year cause-specific survival in univariate analysis. Clinical stage (I vs. II or III) was not a significant predictor of outcome in univariate analysis. Multivariate analysis of the above factors revealed FIGO stage in addition to grade, age and depth by thirds to be independent predictors of outcome. In conclusion, the FIGO surgical staging system better predicts outcome compared with the prior clinical staging system, although the FIGO substaging needs refinement. Grade, age, and depth by thirds are equally important prognostic factors in addition to FIGO stage and can add to the predictive value of the current FIGO staging system.