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The FIGO Stage IVA Versus IVB of Ovarian Cancer: Prognostic Value and Predictive Value for Neoadjuvant Chemotherapy
  1. Parvin Tajik, MD, PhD*,,,
  2. Roelien van de Vrie, MD,
  3. Mohammad H. Zafarmand, MD, PhD,
  4. Corneel Coens, MSc§,
  5. Marrije R. Buist, MD, PhD,
  6. Ignace Vergote, MD, PhD,
  7. Patrick M.M. Bossuyt, PhD and
  8. Gemma G. Kenter, MD, PhD
  1. * Departments of Pathology and
  2. Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Centre;
  3. Department of Obstetrics and Gynaecology, Centre for Gynaecologic Oncology Amsterdam, Academic Medical Centre, Amsterdam, the Netherlands;
  4. § The European Organization for Research and Treatment of Cancer Headquarters, Brussels, Belgium; and
  5. Department of Obstetrics and Gynaecology, Division of Gynaecological Oncology and Leuven Cancer Institute, University Hospitals, K. U. Leuven, Leuven, Belgium.
  1. Address correspondence and reprint requests to Parvin Tajik, MD, PhD, Department of Pathology, Academic Medical Centre – University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands Room M2-106; PO Box 22660. E-mail: P.Tajik{at}


Objective The revised version of the International Federation of Gynaecology and Obstetrics (FIGO) staging system (2014) for epithelial ovarian cancer includes a number of changes. One of these is the division of stage IV into 2 subgroups. Data on the prognostic and predictive significance of this classification are scarce. The effect of neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) in relation to the subclassification of FIGO stage IV is also unknown.

Methods We used data of the EORTC 55971 trial, in which 670 patients with previous stage IIIC or IV epithelial ovarian cancer were randomly assigned to PDS or NACT; 160 patients had previous stage IV. Information on previous FIGO staging and presence of pleural effusion with positive cytology were used to classify tumors as either stage IVA or IVB. We tested the association between stage IVA/IVB and survival to evaluate the prognostic value and interactions between stage, treatment, and survival to evaluate the predictive performance.

Results Among the 160 participants with previous stage IV disease, 103 (64%) were categorized as stage IVA and 57 (36%) as stage IVB tumors. Median overall survival was 24 months in FIGO stage IVA and 31 months in stage IVB patients (P = 0.044). Stage IVB patients treated with NACT had 9 months longer median overall survival compared with IVB patients undergoing PDS (P = 0.025), whereas in IVA patients, no significant difference was observed (24 vs 26 months, P = 0.48).

Conclusions The reclassification of FIGO stage IV into stage IVA or IVB was not prognostic as expected. Compared with stage IVA patients, stage IVB patients have a better overall survival and may benefit more from NACT.

  • Ovarian cancer
  • New FIGO classification
  • Stage IV epithelial ovarian cancer
  • Overall survival
  • Subgroup
  • Lymph node metastasis

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  • The authors declare no conflicts of interest.