Is the International Federation of Gynecology and Obstetrics staging system for cervical carcinoma able to predict survival in patients with cervical carcinoma? An assessment of clinimetric properties

Abstract

BACKGROUND. The objective of this article was to assess the clinimetric properties of the International Federation of Gynecology and Obstetrics (FIGO) staging system of cervical carcinoma to determine whether it is an adequate prognostic tool for the survival of patients with cervical carcinoma. METHODS. The FIGO staging system for cervical carcinoma was evaluated with regard to item generation, item reduction, sensibility, reliability, and validity. RESULTS. Many statistically significant and clinically important variables have been omitted from the current staging system for cervical carcinoma. The item-reduction step for the formulation of the prognostic tool has not been described by the authors of the FIGO staging system, but a consensus process is assumed. There are no studies currently available to assess the reliability of interobserver and intraobserver variability in applying the staging system to patients with cervical carcinoma. A trial to assess the reliability of this tool is proposed by the authors. Although there are no prospective trials to assess the criterion validity of the FIGO staging system, there is enough literature to suggest that the staging system is not capable of discriminating with regard to patient survival within and between stages. CONCLUSIONS. The current FIGO staging system for cervical carcinoma does not fully meet the majority of methodologic criteria for a strong predictive tool. Developing an improved prognostic index containing a complete array of independently prognostic variables is suggested. © 2001 American Cancer Society.