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

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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The Revised 2009 FIGO Staging System for Endometrial Cancer: Should the 1988 FIGO Stages IA and IB Be Altered?

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820cc305 ◽

2011 ◽

Vol 21 (3) ◽

pp. 511-516 ◽

Cited By ~ 31

Author(s):

Nadeem R. Abu-Rustum ◽

Qin Zhou ◽

Alexia Iasonos ◽

Kaled M. Alektiar ◽

Mario M. Leitao ◽

...

Keyword(s):

Endometrial Cancer ◽

Prediction Models ◽

Predictive Ability ◽

Staging System ◽

Stage I ◽

Oncologic Outcomes ◽

Figo Staging ◽

Primary Surgery ◽

Gynecology And Obstetrics ◽

Stage Ia

ObjectivesThe revised 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer included many changes over the 1988 system, particularly for stage I subgroups. We sought to describe the overall survival (OS) of women with stage I endometrial cancer and examine how the estimated stage-specific OS is altered in the 2009 system.MethodsA prospectively maintained institutional endometrial database was analyzed. All patients underwent primary surgery between January 1993 and June 2009.ResultsData from 1658 women were analyzed, including 1307 patients with FIGO 1988 stage I disease. The 5-year OS for the 1988 stages IA (92.4%), IB (87.3%), and IC (75.7%) significantly differed (P < 0.001). When patients were restaged using the 2009 system, we identified 1411 stage I patients with 5-year OS for 2009 stage IA of 89.2%, versus OS of 75.1% for IB (P = 0.001). The adjusted concordance probabilities for the 1988 stage I group and 2009 stage I group were 0.612 (SD, 0.0014) and 0.536 (SD, 0.0111), respectively.ConclusionsThe 1988 FIGO classification of stage I endometrial cancer correctly identified 3 subgroups of patients who had significantly different OS. Specifically, 1988 FIGO stages IA and IB had distinct oncologic outcomes. The revised 2009 system eliminates the most favorable group from the new classification system, and estimates of stage-specific OS for stage IB are substantially altered by the changes made in 2009. The revised system for stage I did not improve its predictive ability over the 1988 system. These data highlight the importance of developing individualized risk-prediction models and nomograms in endometrial cancer.

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Validation of The 2018 FIGO Staging System for Predicting The Prognosis of Patients With Stage IIIC Cervical Cancer

10.21203/rs.3.rs-708694/v1 ◽

2021 ◽

Author(s):

Xingtao Long ◽

Qi Zhou ◽

Dongling Zou ◽

Dong Wang ◽

Jingshu Liu ◽

...

Keyword(s):

Cervical Cancer ◽

Multivariable Analysis ◽

Staging System ◽

Risk Of Death ◽

T Stage ◽

Figo Staging ◽

Gynecology And Obstetrics ◽

Risk Of Mortality ◽

Increased Risk ◽

Standardized Treatment

Abstract Purpose We aimed to validate the prognostic performance of the 2018 International Federation of Gynecology and Obstetrics(FIGO) IIIC staging system for patients with cervical cancer. Methods We conducted a retrospective analysis of patients with stage III cervical cancer according to the 2018 FIGO staging system who received standardized treatment from January 2011 to December 2014. Results Multivariable analysis revealed that stage IIIC1 was not significantly associated with increased risk of death compared with stages IIIA (hazard ratio [HR] = 1.432; 95% confidence interval [CI]: 0.867 to 2.366; P = 0.161) and IIIB (HR = 1.261; 95% CI: 0.871 to 1.827; P = 0.219). Stage IIIC2 was an independent indicator of increased risk of mortality compared with stages IIIA (HR = 2.958; 95% CI :1.757 to 4.983; P < 0.001) and IIIB (HR = 2.606; 95% CI: 1.752 to 3.877; P < 0.001). We stratified patients with stage IIIC1 according to T stage and compared survival outcomes. Stage IIIC1 (T1) was associated with longer 5-year overall survival (OS) compared with stages IIIA (P = 0.004) or IIIB (P < 0.001). An optimal cut-off value (= 2) was established for predicting the prognosis of stage IIIC1p(T1/T2a), which was associated with the number of pelvic lymph nodes metastases (PLNMs). Patients with stage IIIC1pN1-2 experienced longer 5-year OS compared those with stages IIIA (P = 0.01) or IIIB (P < 0.001). Conclusion Patients with stage IIIC1 cervical cancer exhibited heterogeneous clinical characteristics reflecting their variable prognoses, depending on T-stage and the extent of PLNMs

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Revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging: A review of gaps and questions that remain

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001257 ◽

2020 ◽

Vol 30 (6) ◽

pp. 873-878 ◽

Cited By ~ 4

Author(s):

Gloria Salvo ◽

Diego Odetto ◽

Rene Pareja ◽

Michael Frumovitz ◽

Pedro T Ramirez

Keyword(s):

Cervical Cancer ◽

Early Stage ◽

Staging System ◽

Cancer Staging ◽

International Federation ◽

Imaging Modalities ◽

Early Stage Disease ◽

Figo Staging ◽

Gynecology And Obstetrics ◽

Parametrial Involvement

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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APPLICATION OF REVISED FIGO 2018 STAGING FOR CARCINOMA CERVIX- A SINGLE INSTITUITIONAL STUDY

10.36106/ijar/0401383 ◽

2020 ◽

pp. 1-2

Author(s):

P. Anandhi

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Medical Records ◽

Advanced Disease ◽

Tertiary Care ◽

Staging System ◽

Carcinoma Cervix ◽

Figo Staging ◽

Gynecology And Obstetrics ◽

Stage Classification

Cervical cancer continues to be one of the most common cancers among females, being the fourth most common after breast, colorectal, and lung cancer[1]. The FIGO 2018 staging system has brought in various pathological and radiological parameters for stage classification to guide treatment related decision making and for better prognostication. OBJECTIVE: The purpose of this study is to analyse the results of stage redistribution by applying 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer patients in a tertiary care cancer centre, who were previously staged according to FIGO 2009. METHODS: Data of all cervical cancer patients who underwent various forms of treatment at our institute including surgery, radiotherapy and chemotherapy from Jan 2013 to Dec 2016 were collected from the Medical Records Department For this study, we re-staged all patients by the FIGO 2018 staging system RESULTS: The data of patients with carcinoma cervix diagnosed in the 4 years between 2013 & 2016 was tabulated according to both 2009 FIGO staging as well as 2018 FIGO staging. Significant up-staging to Stage IIIC1 & IIIC2 was noted. (Table 1& 2) CONCLUSION: The current FIGO 2018 staging system for cervical cancer appears to be useful for predicting survival in patients considering radiological and pathological variables. As per our study, majority of the cancer cervix patients fall into a single subgroup – III C1; this, in a country were already most patients present with advanced disease, will skew the data further. Stage III C1 cervical cancer is not homogenous; sub classification within stage IIIC1 may result in better prognostication.

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FIGO 2018 Staging for Cervical Cancer: Influence on Stage Distribution and Outcomes in the 3D-Image-Guided Brachytherapy Era

Cancers ◽

10.3390/cancers12071770 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1770

Author(s):

Kento Tomizawa ◽

Takuya Kaminuma ◽

Kazutoshi Murata ◽

Shin-ei Noda ◽

Daisuke Irie ◽

...

Keyword(s):

Cervical Cancer ◽

Progression Free Survival ◽

Staging System ◽

Cervical Squamous Cell Carcinoma ◽

Stage Migration ◽

Cervical Cancers ◽

Stage Distribution ◽

Image Guided ◽

Figo Staging ◽

Gynecology And Obstetrics

Recent widespread use of three-dimensional image-guided brachytherapy (3D-IGBT) has improved radiotherapy outcomes of cervical cancer dramatically. In 2018, the International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer was revised. However, the influence of the revisions on the stage distribution and outcomes of cervical cancers treated with 3D-IGBT remains unclear. Here, we retrospectively analyzed 221 patients with cervical squamous cell carcinoma treated with definitive radiotherapy using 3D-IGBT (median follow-up, 60 months). The stage distribution and outcomes were compared between the 2009 and 2018 schemas. Stage migration occurred in 52.9% of the patients. Patients classified with the 2018 criteria as stage IIICr had the highest proportion (43.8%) of migration, and were mainly from the 2009 stages IIB and IIIB. The 2009 and 2018 schemas showed comparable performance at stratifying 5-year overall survival (OS) and 5-year progression-free survival (PFS) for patients in stages IB–IVA. The 2018 criteria effectively stratified 5-year OS and PFS in the stage III substages. The 5-year OS and PFS for stage IIIC1r patients varied according to tumor T stage. These data provide evidence for the utility of the revised 2018 FIGO staging system in the clinical management of cervical cancers in the 3D-IGBT era.

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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

Medicine ◽

10.1097/md.0000000000019714 ◽

2020 ◽

Vol 99 (16) ◽

pp. e19714

Author(s):

Jing Zeng ◽

Pengpeng Qu ◽

Yuanjing Hu ◽

Peisong Sun ◽

Ji Qi ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Staging System ◽

International Federation ◽

Gynecology And Obstetrics ◽

Early Cervical Cancer

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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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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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