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

2020 ◽  
Vol 30 (6) ◽  
pp. 873-878 ◽  
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.

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

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.

scholarly journals The Use of Sensitive Imaging Modalities for Cervical Cancer Staging in Japan

2019 ◽  
Vol 11 (3) ◽  
pp. 75
Author(s):  
Takahiro Higashi ◽  
Tomone Watanabe ◽  
Momoko Iwamoto ◽  
Mikio Mikami
Keyword(s):  
Cervical Cancer ◽  
Cancer Staging ◽  
Stage Ii ◽  
Imaging Modalities ◽  
First Line ◽  
Figo Staging ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pet Ct ◽  
Stage Stage

The International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer did not take into account any of the findings determined by imaging modalities as part of the staging work-up. However, in the Japanese clinical settings, computed tomography (CT) and magnetic resonance imaging (MRI) are frequently used. In this study, we aimed to describe the pretreatment use of sensitive imaging modalities in Japan in order to assess the future adaptability of the FIGO staging system.Data from September 2012 to December 2014 were collected from the National Database of the Hospital-Based Cancer Registry and health insurance claims data. A total of 280 hospitals participated. From the database, all patients with cervical cancer who received first-line therapy at the participating hospitals were analyzed. The proportions of patients who had CT, MRI, and positron emission tomography-CT (PET-CT) before receiving the first-line therapy were calculated. For comparison, the proportions of patients who had undergone cystoscopy and/or proctoscopy -- examinations that are incorporated into the FIGO system -- were also calculated. A total of 13 668 patients were included; 77.3% of patients had early stage (stage 0 or I) disease. Among all patients, 88.5% had undergone CT, MRI, or PET-CT before receiving the first-line therapy. Additionally, over 90% of patients with advanced-stage (stage II&ndash;IV) disease had undergone CT. Conversely, only 21.0% of patients with stage II&ndash;IV disease were reported to have undergone cystoscopy and/or proctoscopy. Promoting a resource-stratified approach in the cervical cancer staging is warranted.

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

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

scholarly journals Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage

Cancers ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3554
Author(s):  
Vincent Balaya ◽  
Benedetta Guani ◽  
Laurent Magaud ◽  
Hélène Bonsang-Kitzis ◽  
Charlotte Ngô ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Early Stage ◽  
Disease Free Survival ◽  
Staging System ◽  
Lymph Node Biopsy ◽  
Disease Stage ◽  
Prognostic Impact ◽  
Gynecology And Obstetrics ◽  
Figo Classification ◽  
Lymphovascular Space Invasion

Background: The aim of this study was to assess the prognostic impact of Lymphovascular space invasion (LVSI) in IB1 stage of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) classification for cervical cancer. Methods: A secondary analysis of two French prospective multicentric trials on Sentinel Lymph node biopsy for cervical cancer was performed. Patients with 2009 FIGO IB1 stage who underwent radical surgery between January 2005 and July 2012 from 28 French expert centers were included. The stage was modified retrospectively according to the new 2018 FIGO staging system. Results: According to the 2009 FIGO classification, 246 patients had IB1 disease stage and fulfilled the inclusion criteria. The median follow-up was 48 months (4–127). Twenty patients (8.1%) experienced a recurrence, and the 5-year Disease Free Survival (DFS) was 90.0%. Compared to 2018 IB1 staged patients, new IB2 had significantly decreased 5-year DFS, 78.6% vs. 92.9%, p = 0.006 whereas IIIC patients had similar 5-year DFS (91.7%, p = 0.95). In the subgroup of patients with FIGO 2018 IB1 stage, the presence of LVSI was associated with a significant decrease in DFS (82.5% vs. 95.8%, p = 0.04). Conclusions: LVSI is associated with decreased 5-year DFS in IB1 2018 FIGO stage and LVSI status should be considered in early-stage cervical cancer for a more precise risk assessment.

Implications of the new FIGO staging and the role of imaging in cercal cancer

2021 ◽  
pp. 20201342
Author(s):  
Aki Kido ◽  
Yuji Nakamoto
Keyword(s):  
Imaging Modality ◽  
Tumour Size ◽  
Staging System ◽  
Cancer Staging ◽  
Imaging Findings ◽  
Figo Staging ◽  
Gynecology And Obstetrics ◽  
Two Factors ◽  
Clinical Background

International Federation of Gynecology and Obstetrics (FIGO) staging, which is the fundamentally important cancer staging system for cervical cancer, has changed in 2018. New FIGO staging includes considerable progress in the incorporation of imaging findings for tumour size measurement and evaluating lymph node (LN) metastasis in addition to tumour extent evaluation. MRI with high spatial resolution is expected for tumour size measurements and the high accuracy of positron emmision tomography/CT for LN evaluation. The purpose of this review is firstly review the diagnostic ability of each imaging modality with the clinical background of those two factors newly added and the current state for LN evaluation. Secondly, we overview the fundamental imaging findings with characteristics of modalities and sequences in MRI for accurate diagnosis depending on the focus to be evaluated and for early detection of recurrent tumour. In addition, the role of images in treatment response and prognosis prediction is given with the development of recent technique of image analysis including radiomics and deep learning.

scholarly journals Stage-Specific Outcomes of Patients With Uterine Leiomyosarcoma: A Comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer Staging Systems

2009 ◽  
Vol 27 (12) ◽  
pp. 2066-2072 ◽  
Author(s):  
Oliver Zivanovic ◽  
Mario M. Leitao ◽  
Alexia Iasonos ◽  
Lindsay M. Jacks ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Uterine Cancer ◽  
Staging System ◽  
International Federation ◽  
Uterine Leiomyosarcoma ◽  
Figo Staging ◽  
American Joint Committee ◽  
Gynecology And Obstetrics ◽  
Staging Systems ◽  
Ajcc Staging System ◽  
Ajcc Staging

Purpose Uterine leiomyosarcoma (LMS) is staged by the modified International Federation of Gynecology and Obstetrics (FIGO) staging system for uterine cancer. We aimed to determine whether the American Joint Committee on Cancer (AJCC) soft tissue sarcoma (STS) staging system is more accurate in predicting progression-free survival (PFS) and overall survival (OS). Patients and Methods Patients with uterine LMS who presented at our institution from 1982 to 2005 were staged retrospectively according to a modified FIGO staging system and the AJCC STS staging system. The predictive accuracy of the two staging systems was compared using concordance estimation. Results Two hundred nineteen patients had sufficient clinical and pathologic information to be staged under both systems; 132 patients were upstaged using the AJCC staging system, whereas only four were downstaged. Stage-specific PFS and OS rates for stages I, II, and III differed substantially between the two staging systems. In both systems, there was prognostic overlap between stages II and III. Thus, despite the marked stage-specific differences in 5-year PFS and OS rates for stages I, II, and III, both systems had similar concordance indices. Conclusion Estimates of stage-specific PFS and OS for uterine LMS were altered substantially when using the AJCC versus FIGO staging system. Adjuvant treatment strategies should be tested in patients at substantial risk for disease progression and death. Neither the FIGO nor AJCC staging system is ideal for identifying such patients, suggesting a need for a uterine LMS-specific staging system to better target patients for trials of adjuvant therapies.

scholarly journals Prognostic Performance of the 2018 International Federation of Gynecology and Obstetrics Cervical Cancer Staging Guidelines

2019 ◽  
Vol 134 (1) ◽  
pp. 49-57 ◽  
Author(s):  
Jason D. Wright ◽  
Koji Matsuo ◽  
Yongmei Huang ◽  
Ana I. Tergas ◽  
June Y. Hou ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Staging ◽  
International Federation ◽  
Prognostic Performance ◽  
Gynecology And Obstetrics
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