Clinicopathological risk factors in the light of the revised 2018 International Federation of Gynecology and Obstetrics staging system for early cervical cancer with staging IB

Recently the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was published. In this most recent classification, imaging modalities and pathologic information have been added as tools to determine the final stage of the disease. Although there are many merits to this new staging for cervical cancer, including more detailed categorization of early-stage disease as well as information on nodal distribution, the classification falls short in clarifying areas of controversy in the staging system. Many unanswered questions remain and, as such, a number of gaps lead to further debate in the interpretation of relevant clinical data. Factors such as measurement of tumor size, definition of parametrial involvement, ovarian metastases, lower uterine segment extension, lymph node metastasis, and imaging modalities are explored in this review. The goal is to focus on items that deserve further discussion and clarification in the most recent FIGO staging for cervical cancer.

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A reappraisal of the international federation of gynecology and obstetrics staging system for cervical cancer. A study of patterns of care

Cancer ◽

10.1002/1097-0142(19920115)69:2<482::aid-cncr2820690235>3.0.co;2-8 ◽

1992 ◽

Vol 69 (2) ◽

pp. 482-487 ◽

Cited By ~ 34

Author(s):

Rachelle M. Lanciano ◽

Minhee Won ◽

Gerald E. Hanks

Keyword(s):

Cervical Cancer ◽

Staging System ◽

International Federation ◽

Patterns Of Care ◽

Gynecology And Obstetrics

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Survival Outcomes in Patients With 2018 FIGO Stage IA2–IIA2 Cervical Cancer Treated With Laparoscopic Versus Open Radical Hysterectomy: A Propensity Score-Weighting Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.682849 ◽

2021 ◽

Vol 11 ◽

Author(s):

Wancheng Zhao ◽

Yunyun Xiao ◽

Wei Zhao ◽

Qing Yang ◽

Fangfang Bi

Keyword(s):

Cervical Cancer ◽

Propensity Score ◽

Cancer Patients ◽

Staging System ◽

Figo Stage ◽

Gynecology And Obstetrics ◽

Early Cervical Cancer ◽

Medical University ◽

Cancer Network ◽

Prognostic Risk Factors

ObjectiveTo compare the survival and recurrence outcomes between open and laparoscopic radically hysterectomy (RH) for stage IA2-IIA2 cervical cancer based on Federation International of Gynecology and Obstetrics (FIGO) 2018.MethodsData of 1,373 early cervical cancer patients undergoing open or laparoscopic radically hysterectomy at ShengJing Hospital of China Medical University between January 1, 2013, and December 31, 2016, were retrospectively reviewed. Propensity score-based inverse probability of treatment weighting (PS-IPTW) was used to balance the covariates between the two groups.ResultsA total of 705 cervical cancer patients of FIGO 2009 stage IA2-IIA2 were finally enrolled in this study. After IPTW adjustment, the OS (HR = 2.095, 95% CI: 1.233-3.562, P = 0.006) and PFS (HR = 1.950, 95%CI: 1.194-3.184, P = 0.008) rates were significantly higher in the open RH (ORH) group compared with the laparoscopic RH (LRH) group. Then after re-staging according to the FIGO 2018 staging system, 561 patients still belonged to stage IA2-IIA2, 144 patients were upgraded to stage IIIC1p-IIIC2p. The ORH group had a significantly superior OS (HR = 1.977, 95%CI: 1.077-3.626, P = 0.028) and PFS (HR = 1.811, 95%CI: 1.046-3.134, P = 0.034) compared with the LRH group after PS-IPTW analysis. Furthermore, in patients with no high and intermediate risks, difference of the OS (HR = 1.386, 95%CI: 0.287-6.69, P = 0.684) and PFS (HR = 1.524, 95%CI: 0.363-6.396, P = 0.565) rates between the two groups were with no statistical meaning.ConclusionsOutcomes of this retrospective cohort study were in compliance with indications for ORH recommended by the National Comprehensive Cancer Network guidelines Version 1, 2021. However, LRH showed non-inferiority for patients with no prognostic risk factors compared with ORH.

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Cervical Cancer: 2018 Revised International Federation of Gynecology and Obstetrics Staging System and the Role of Imaging

American Journal of Roentgenology ◽

10.2214/ajr.19.21819 ◽

2020 ◽

Vol 214 (5) ◽

pp. 1182-1195

Author(s):

Mohammed Saleh ◽

Mayur Virarkar ◽

Sanaz Javadi ◽

Sherif B. Elsherif ◽

Silvana de Castro Faria ◽

...

Keyword(s):

Cervical Cancer ◽

Staging System ◽

International Federation ◽

Gynecology And Obstetrics

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Staging early cervical cancer in China: data from a multicenter collaborative

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2019-000263 ◽

2019 ◽

Vol 29 (5) ◽

pp. 869-873 ◽

Cited By ~ 9

Author(s):

Weifeng Zhang ◽

Chunlin Chen ◽

Ping Liu ◽

Weili Li ◽

Min Hao ◽

...

Keyword(s):

Cervical Cancer ◽

Surgical Treatment ◽

Neoadjuvant Treatment ◽

Staging System ◽

Clinical Staging ◽

Tumor Diameter ◽

Figo Staging ◽

Gynecology And Obstetrics ◽

Stage Ia ◽

Early Cervical Cancer

BackgroundIn 2018 the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system of cervical cancer. This study aimed to assess the quality of staging early cervical cancer in China before the revision.MethodsThis multicenter retrospective study included 34 tertiary hospitals in China. Medical records of patients with cervical cancer who underwent primary surgical treatment between January 2010 and December 2015 were reviewed retrospectively. All patients were clinically staged according to the 2009 FIGO staging system. Eligibility criteria included: histopathologically confirmed cervical cancer; 2009 FIGO stage IA–IIA2 based on 2009 FIGO staging system; primary surgical treatment including extrafascial, type II or type III radical hysterectomy; radical trachelectomy; with or without pelvic lymphadenectomy; regardless of surgical route via laparotomy or laparoscopy; and complete clinical and pathological data. Patients who received non-surgical treatment, neoadjuvant treatment, or those with incomplete data were excluded. The accuracy of clinical staging was assessed by comparison between clinical and pathologic stage using the latter as the reference standard.ResultsA total of 23 933 cases of cervical cancer were identified and 12 681 fulfilled the inclusion criteria. Of these patients, 69.6% were staged accurately, 9.4% were clinically understaged, and 21.0% were clinically overstaged. The accuracy of stage IA, IB1, IB2, IIA1, and IIA2 was 90.0%, 87.5%, 57.4%, 20.3%, and 25.5%, respectively. The causes of stage inaccuracy were as follows: vaginal involvement (62.3%), maximal tumor diameter (24.6%), extent of cervical stromal invasion (7.1%), parametrial invasion (5.8%), bladder or rectal infiltration (0.1%), and distant metastases (0.1%).ConclusionThe accuracy of staging early cervical cancer in China was suboptimal before the revision of the staging system, especially for IIA1 and IIA2. The most common reasons for staging inaccuracy were vaginal involvement and tumor diameter.

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Comparing survival outcomes for cervical cancer based on the 2014 and 2018 International Federation of Gynecology and Obstetrics staging systems

Scientific Reports ◽

10.1038/s41598-021-86283-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wonkyo Shin ◽

Tae Young Ham ◽

Young Ran Park ◽

Myong Cheol Lim ◽

Young-Joo Won

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Staging System ◽

International Federation ◽

Lymph Node Status ◽

Survival Outcomes ◽

Stage Iiic ◽

Figo Staging ◽

Gynecology And Obstetrics ◽

Staging Systems

AbstractThe International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging system was modified in 2018, introducing new stage IB subdivisions and new lymph node status considerations in stage IIIC. We compared cervical cancer survival outcomes according to the 2014 and 2018 FIGO staging systems. We selected 10% of cervical cancer cases (2010–2015) from the Korean national cancer registry (2010–2015) through a systematic sampling method. We collected information using a collaborative stage data collection system and evaluated the results according to both staging systems. The log-rank test was used to analyze overall survival differences. No significant difference in survival was observed between 2018 subdivisions IB1/IB2/IB3 (P = 0.069), whereas a considerable difference was observed between these subdivisions according to histological subtypes. In the 2018 FIGO staging system, stage IIIC had better survival than stage IIIA/IIIB (P < 0.001). We observed considerable heterogeneity in 2018 stage IIIC related to the corresponding stages of the 2014 staging system (stages IA1–IIIB). The size of the primary cervical mass was related to survival (P < 0.001). In conclusion, using lymph node status to define stage IIIC captured a broad range of prognoses. The inclusion of primary tumor size considerations may improve the staging accuracy of advanced cervical cancer.

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Contributions of the newly revised 2018 international federation of gynecology and obstetrics staging of cervical cancer

Medicinski pregled ◽

10.2298/mpns2006158s ◽

2020 ◽

Vol 73 (5-6) ◽

pp. 158-163

Author(s):

Bojana Scepanovic ◽

Nikola Andjelic ◽

Dejan Nincic ◽

Natasa Prvulovic-Bunovic

Keyword(s):

Cervical Cancer ◽

Invasive Cervical Cancer ◽

Staging System ◽

International Federation ◽

Cervix Uteri ◽

International Agency ◽

Lymph Node Status ◽

Pathological Findings ◽

Gynecology And Obstetrics ◽

Made In

Introduction. According to the latest data from International Agency for Research on Cancer from 2018, global burden of cancer cervical cancer is the fourth most common cancer in women worldwide. The aim of this article was to present the contributions of the new, revised 2018 International Federation of Gynecology and Obstetrics staging of carcinoma of the cervix uteri, allowing much more precise staging with the use of any imaging modalities and/or pathological findings to allocate the stage and provide more effective treatment. International Federation of Gynecology and Obstetrics staging system. The main changes in the new staging system were made in IB stage of the disease, which now includes 3 subgroups i.e. substages for every 2 cm increments in tumor size: stage IB1 (< 2 cm), stage IB2 disease (2 to < 4 cm), and stage IB3 (? 4 cm). This system also incorporates the lymph node status into stage III cervical cancer, allowing imaging and/or pathological findings of lymph nodes to the pelvic and/or para-aortic nodes to assign stage IIIC disease. Conclusion. The main goal of the new staging system revision was to improve the accuracy of staging in order to provide more refined understanding of prognostic groups and facilitate better treatment for women with invasive cervical cancer.

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