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The purpose of this study was to retrospectively validate the prognostic value of revised 2018 FIGO stage IIIC This is a retrospective analysis of patients with cervical cancer in stage III of the revised 2018 FIGO Staging System who received standardized treatment from 2011 to 2014 at a cancer hospital. Multi-group comparisons were performed with the Kruskal-Wallis H test and chi-square test. Survival curves were calculated using the Kaplan-Meier method and the log-rank test. A Cox proportional hazard regression model was used for multivariable analysis. A total of 418 women were included, 42(10.0%) stage IIIA, 120(28.7%) stage IIIB, 190(45.5%) stage IIIC1 and 66(15.8%) stage IIIC2, there was no significant difference in histological type, tumor differentiation, tumor size, type of radiotherapy, consolidation chemotherapy among the four groups (all, P > 0.05). The stage IIIC1 patients were younger compared to those with stage IIIA (P <0.001) and IIIB(P =0.01). On univariate survival analyses, the 2018 FIGO staging system was significantly associated with survival in stage III cervical cancer (P <0.001). Women with stage IIIC1 disease had significantly improved survival compared to those with stage IIIC2 (P <0.001); Survival of women with stage IIIC1 was similar compared to those IIIA (P =0.484) and IIIB (P =0.042) (5-year OS rates:54.1% for IIIC1, 43.3% for IIIA, 40.6% for IIIB, 23.1% for IIIC2). In a multivariable model, stage IIIC2 disease was independently associated with a two-fold increased mortality risk compared to stage IIIC1 (HR = 2.066, 95% CI: 1.438-2.969, P <0.001), 2.6-fold compared to stage IIIB (HR=2.606, 95% CI 1.752-3.877, P <0.001) or nearly 3-fold compared to stage IIIA (HR = 2.958, 95% CI 1.757-4.983, P <0.001). Survival of stage IIIC1 disease significantly differed based on T-stage (5-year OS rates:72.2% for T1 vs 54.1% for T2 vs 18.6% for T3, P <0.001). Patients with stage IIIC1 (T1) had better OS compared with stage IIIA (P =0.004) and IIIB (P <0.001); Patients with stage IIIC1(T3) had worse OS compared with stage IIIA and IIIB (both P =0.001). On multivariable analysis, T-stage remained an independent prognostic factor for survival in patients with 2018 FIGO stage IIIC1 (P <0.001). Stage IIIC1(T1) was independently associated with improved survival compared to stage IIIA (HR = 0.514, 95% CI 0.287-0.921, P =0.025) or stage IIIB disease (HR = 0.420, 95% CI 0.263-0.672, P <0.001). The best prognostic cut-off value of the number of metastatic pelvic lymph node (MPLNs) was 2 for stage IIIC1p(T1/T2a). Patients with >2 MPLNs had worse OS compared with those having <2 (5-year OS rates were 76% and 47.9%, respectively, P <0.001). Multivariate analyses demonstrated that the extent of MPLNs yield impact on OS(HR = 2.753, 95% CI 1.527-4.965, P =0.001). Patients with stage IIIC1 represent a heterogeneous population with a variable prognosis, using T stage and a cut-off value of 2 MPLNs could gain a better predict prognostic outcomes. [ABSTRACT FROM AUTHOR]