Perceptions of Controversies and Unresolved Issues in the 2014 FIGO Staging System for Endometrial Cancer: Survey Results From Members of the International Society of Gynecological Pathologists and International Gynecologic Cancer Society.

IF 1.6 4区 医学 Q3 OBSTETRICS & GYNECOLOGY
Neslihan Kayraklioglu, Levon Katsakhyan, Paul A Cohen, Naveena Singh, Joseph T Rabban, Xavier Matias-Guiu
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引用次数: 0

Abstract

Long-standing controversial and unresolved issues in the current "International Federation of Gynecology and Obstetrics" staging system for endometrial cancer are well-recognized by pathologists and clinicians alike and exist primarily as a result of limitations to the existing literature. To guide the design of future outcome-based studies specifically aimed at resolving such gaps, the International Society of Gynecologic Pathologists developed a survey of the current perceptions of pathologists (n = 172) and clinicians (n= 135) from the International Society of Gynecological Pathologists and from the International Gynecologic Cancer Society on areas for potential refinement of the current International Federation of Gynecology and Obstetrics staging system. The highest priority issues for pathologists and clinicians alike were the need to determine whether stage IIIA patients (ovarian/fallopian tube involvement) can be reliably separated into favorable versus unfavorable outcome groups to avoid over-treatment of the former group and to determine whether stage IIIC patients (lymph node metastases) can be separated into favorable versus unfavorable outcome groups based on the size of lymph node metastases. The majority of pathologists and clinicians viewed lymphovascular space invasion as an independent prognostic variable and favored incorporating lymphovascular space invasion into staging, though the level of support did not meet the threshold of 75% in support that we used to define a formal consensus. While pathologists did agree on the prognostic value of reporting the extent of lymphovascular space invasion, there was no consensus on the diagnostic criteria to distinguish focal versus substantial involvement. The majority of pathologists and clinicians viewed that a universally accepted protocol for sentinel lymph node ultra-staging is lacking. Both survey groups conveyed a slight preference for incorporating tumor histotype and molecular classification into staging but the support was short of the 75% threshold for formal consensus. Collectively, this survey permits the International Society of Gynecological Pathologists to develop a pathologist and clinician-driven long-term strategy for prioritizing and designing outcome-based studies specifically targeted to resolving controversial and unresolved issues in the International Federation of Gynecology and Obstetrics staging of endometrial cancer.

对 2014 FIGO 子宫内膜癌分期系统中存在的争议和未决问题的看法:国际妇科病理学家协会和国际妇科癌症协会会员调查结果。
病理学家和临床医生都清楚地认识到,目前 "国际妇产科联盟 "子宫内膜癌分期系统中长期存在的争议和未解决的问题,这主要是由于现有文献的局限性造成的。为了指导设计未来以结果为基础的研究,专门解决这些差距,国际妇科病理学家协会对国际妇科病理学家协会和国际妇科癌症协会的病理学家(n=172)和临床医生(n=135)目前对当前国际妇产科联合会分期系统可能改进的领域的看法进行了调查。病理学家和临床医生最优先考虑的问题是,需要确定是否能可靠地将 IIIA 期患者(卵巢/输卵管受累)分为预后良好组和预后不良组,以避免对前者进行过度治疗,以及确定是否能根据淋巴结转移的大小将 IIIC 期患者(淋巴结转移)分为预后良好组和预后不良组。大多数病理学家和临床医生认为淋巴管间隙侵犯是一个独立的预后变量,并赞成将淋巴管间隙侵犯纳入分期,尽管支持率未达到我们用来定义正式共识的 75% 的支持率阈值。虽然病理学家对报告淋巴管间隙受侵程度的预后价值达成了一致,但对区分局灶性和实质性受累的诊断标准却没有达成共识。大多数病理学家和临床医生认为,前哨淋巴结超分期缺乏普遍接受的方案。两个调查组都表示略微倾向于将肿瘤组织型和分子分类纳入分期,但支持率未达到达成正式共识的 75% 临界值。总之,这项调查使国际妇科病理学家协会能够制定一项由病理学家和临床医生主导的长期战略,优先考虑和设计基于结果的研究,专门解决国际妇产科联盟子宫内膜癌分期中存在的争议和未决问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.90
自引率
12.50%
发文量
154
审稿时长
6-12 weeks
期刊介绍: International Journal of Gynecological Pathology is the official journal of the International Society of Gynecological Pathologists (ISGyP), and provides complete and timely coverage of advances in the understanding and management of gynecological disease. Emphasis is placed on investigations in the field of anatomic pathology. Articles devoted to experimental or animal pathology clearly relevant to an understanding of human disease are published, as are pathological and clinicopathological studies and individual case reports that offer new insights.
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