A Suggested Modification to FIGO Stage IV Epithelial Ovarian Cancer

SIMPLE SUMMARY: The identification of prognostic factors is important to improve the management of patients with ovarian cancer (OC). The staging classification of OC was revised in 2014 and 2018 by the FIGO (International Federation of Gynecology and Obstetrics) Gynecological Oncology Committee and dichotomizes stages IV into stage IVA and IVB. The FIGO classification aims to establish a disease severity scale and to group patients with similar prognoses. The objective of our retrospective, multicenter study was to assess the prognostic impact of this dichotomization and of the initial metastatic localization of patients with FIGO stage IV OC. We showed that, among our 307 patients, FIGO stage IVA patients had a worse prognosis than FIGO stage IVB patients. The initial pleural effusion was a factor of poor prognosis in terms of overall survival. We suggest a modification of the current FIGO staging classification. ABSTRACT: International Federation of Gynecology and Obstetrics (FIGO) staging classification for stage IV epithelial ovarian cancer (EOC) separates stages IVA (pleural effusion) and IVB (parenchymal and/or extra-abdominal lymph node metastases). We aimed to evaluate its prognostic impact and to compare survival according to the initial metastatic location. We conducted a multicenter study between 2000 and 2020, including patients with a FIGO stage IV EOC. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS) and recurrence rates. We included 307 patients: 98 (32%) had FIGO stage IVA and 209 (68%) had FIGO stage IVB. The median OS and PFS of stage IVA patients were significantly lower than those of stage IVB patients (31 versus 45 months (p = 0.02) and 18 versus 25 months (p = 0.01), respectively). Recurrence rate was higher in stage IVA than IVB patients (65% versus 47% (p = 0.004)). Initial pleural involvement was a poor prognostic factor with a median OS of 35 months versus 49 months for patients without initial pleural involvement (p = 0.024). Patients with FIGO stage IVA had a worse prognosis than patients with FIGO stage IVB EOC. Pleural involvement appears to be relevant for predicting survival. We suggest a modification of the current FIGO staging classification.