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Original research
Validation of the 2021 FIGO staging schema for advanced vulvar cancer
  1. Koji Matsuo1,2,
  2. Maximilian Klar3,
  3. Shin Nishio4,
  4. Mikio Mikami5,
  5. Lynda D Roman1,2 and
  6. Jason D Wright6
  1. 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California, USA
  2. 2Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
  3. 3Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
  4. 4Department of Obstetrics and Gynecology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
  5. 5Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  6. 6Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York, USA
  1. Correspondence to Dr Koji Matsuo, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; koji.matsuo{at}med.usc.edu

Abstract

Objective The International Federation of Gynecology and Obstetrics (FIGO) revised the vulvar cancer staging schema in 2021. Previous stage IIIA–B diseases were reclassified based on nodal size (≤5 mm for stage IIIA compared with >5 mm for stage IIIB), and previous stage IVA1 disease based on non-osseous organ extension was reclassified to stage IIIA whereas osseous extension remained as stage IVA. This study sought to validate the 2021 FIGO vulvar cancer staging schema.

Methods This retrospective cohort study examined 889 women with stage III–IV vulvar cancer from 2010 to 2015 in the National Cancer Institute’s Surveillance, Epidemiology, and End Results Program. Stage shift and overall survival were assessed by comparing the 2021 and 2009 FIGO staging schemas.

Results Stage shift occurred in 229 (25.8%) patients (upstaged 17.7% and downstaged 8.1%). When comparing the new and previous staging schemas, 5 year overall survival rates were 45.6% versus 48.9% for stage IIIA, 47.0% versus 44.2% for stage IIIB, and 13.9% versus 25.1% (interval change −11.2%) for stage IVA diseases. According to the revised staging schema, 5 year overall survival rates were similar for stage IVA and IVB diseases (13.9% vs 14.5%) and for stage IIIA and IIIB disease (45.6% vs 47.0%). For new stage IIIA disease, 5 year overall survival rates differed significantly based on the staging factors (nodal involvement vs non-nodal organ involvement, 48.9% vs 38.7%, difference 10.2%, p=0.038).

Conclusion The 2021 FIGO staging schema results in one in four cases of advanced vulvar cancer being reclassified. Survival rates of patients with new stage IVA disease worsened significantly whereas those of patients with new stage IIIA disease were heterogenous based on the staging factors. The discriminatory ability of the revised 2021 FIGO staging schema for 5 year overall survival rate between patients with stage IIIA and IIIB tumors and those with IVA and IVB tumors is limited in this study population.

  • vulvar neoplasms

Data availability statement

Data are available in a public, open access repository. All the data that support the findings of this study are publicly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program at http://seer.cancer.gov/.

https://doi.org/10.1136/ijgc-2021-003168

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    Data availability statement

    Data are available in a public, open access repository. All the data that support the findings of this study are publicly available in The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program at http://seer.cancer.gov/.

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    Footnotes

    • Contributors Conceptualization: KM, MM. Data curation: KM. Formal analysis: KM. Funding acquisition: KM, LDR. Investigation: all authors. Methodology: KM, MK. Project administration: KM. Resources: KM. Software: KM. Supervision: MK, LDR, JDW. Validation: KM. Visualization: KM. Writing - original draft: KM. Writing - review and editing: all authors. Guarantor: KM.

    • Funding Ensign Endowment for Gynecologic Cancer Research (KM).

    • Disclaimer The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    • Competing interests All were outside the work: honorarium, Chugai, textbook editorial expense, Springer, investigator meeting attendance expense, VBL Therapeutics (KM); consultant, Clovis Oncology, research grant, Merck, royalties, UpToDate (JDW); consultant, Quantgene (LDR).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.