Validation of the new FIGO staging system (2009) for vulvar cancer in the Chinese population

- The 2009 FIGO staging system for vulvar cancer is efficient in the subdivisions of stage III disease.
- It failed to stratify survival well between stages IB, II and IIIA.
- It created a relatively small group of patients who can be classified as stage II

ObjectiveA new FIGO staging system for vulvar cancer was issued in 2009. The aim of this study was to identify its value in estimating the outcome of patients with vulvar squamous cell carcinoma (VSCC) in the Chinese population.MethodsA total of 184 patients who underwent radical surgery for VSCC were recruited. Their medical records and pathology slides were reviewed. Disease reclassification was conducted according to the FIGO staging system (2009). The primary outcomes were cause-specific survival (CSS), relapse-free survival (RFS) and overall survival (OS).ResultsA total of 76 patients (41.3%) were downstaged and no patients were upstaged in the new FIGO staging system (2009). The stage distribution was as follows: stage I (99), stage II (13), stage III (65) and stage IV (7). According to CSS, the patients were classified into 4 groups: stage IA (group 1), stage IB/II/IIIA (group 2), stage IIIB (group 3), and stage IIIC/IV (group 4) (5-year CSS: 100%, 85%, 34.6% and 0%, respectively). The 5-year CSS was similar among the patients with stage IB, II and IIIA carcinomas (84.4%, 84.6% and 84.8%, respectively, p = 0.986), whereas, significant decline of the CSS was found with increased substages of stages IIIA, IIIB and IIIC (84.8%, 34.6%, and 0 respectively, p < 0.001).ConclusionsThe 2009 FIGO staging system for VSCC displayed good performance for the subdivisions of stage III VSCC, but it failed to stratify survival well between stages IB, II and IIIA.