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Validation of the FIGO 2009 Staging System for Carcinoma of the Vulva
  1. Jason Tan, MBBS, FRANZCOG, CGO*,,
  2. Naven Chetty, MBBS, FRANZCOG, CGO*,,
  3. Srinivas Kondalsamy-Chennakesavan, MBBS, MPH,
  4. Alex Crandon, MBBS, FRANZCOG, CGO,
  5. Andrea Garrett, MBBS, FRANZCOG, CGO*,
  6. Russell Land, MBBS, FRANZCOG, CGO*,
  7. Marcelo Nascimento, MD, FRANZCOG, CGO,
  8. Jim Nicklin, MBBS, FRANZCOG, CGO*,
  9. Lewis Perrin, MBBS, FRANZCOG, CGO and
  10. Andreas Obermair, MD, FRANZCOG, CGO*,
  1. * Department of Gynaecological Oncology, Royal Brisbane and Women’s Hospital, Brisbane;
  2. Mater Hospital, Brisbane; and
  3. School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
  1. Address correspondence and reprint requests to Srinivas Kondalsamy-Chennakesavan, MBBS, MPH, PO Box 213, Royal Brisbane Hospital, Herston 4029, Australia. E-mail: uqskonda{at}


Background The previous (1988) International Federation of Gynecology and Obstetrics (FIGO) vulval cancer staging system failed in 3 important areas: (1) stage 1 and 2 disease showed similar survival; (2) stage 3 represented a most heterogeneous group of patients with a wide survival range; and (3) the number and morphology of positive nodes were not taken into account.

Objective To compare the 1988 FIGO vulval carcinoma staging system with that of 2009 with regard to stage migration and prognostication.

Methods Information on all patients treated for vulval cancer at the Queensland Centre for Gynecological Cancers, Australia, between 1988 to the present was obtained. Data included patients’ characteristics as well as details on histopathology, treatments, and follow-up. We recorded the original 1988 FIGO stage, reviewed all patients’ histopathology information, and restaged all patients to the 2009 FIGO staging system. Data were analyzed using the Kaplan-Meier method to compare relapse-free survival and overall survival.

Results Data from 394 patients with primary vulval carcinoma were eligible for analysis. Patients with stage IA disease remained unchanged. Tumors formerly classified as stage II are now classified as stage IB. Therefore, FIGO 2009 stage II has become rare, with only 6 of 394 patients allocated to stage II. Stage III has been broken down into 3 substages, thus creating distinct differences in relapse-free survival and overall survival. Prognosis of patients with stage IIIC disease is remarkably poor.

Conclusion The FIGO 2009 staging system for vulval carcinoma successfully addresses some concerns of the 1988 system. Especially, it identifies high-risk patients within the heterogeneous group of lymph node–positive patients.

  • Vulva
  • Carcinoma
  • FIGO
  • Staging
  • 2009

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