Clinically significant discrepancy between clinical and pathologic stage of early-operable cervical cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5526-5526
Author(s):  
Jennifer Gibbs ◽  
Victoria Hastings ◽  
Nikita Malakhov ◽  
Katherine Economos ◽  
Margaux J Kanis
Keyword(s):  
Cervical Cancer ◽  
Final Analysis ◽  
Staging System ◽  
Figo Stage ◽  
Adjuvant Radiation ◽  
Significant Discrepancy ◽  
Mean Error ◽  
Significant Difference ◽  
Parametrial Involvement ◽  
Clinically Significant

5526 Background: The cornerstone of the management of cervical cancer (CC) traditionally relies on clinical examination assessment (CE) of tumor size (TS) and local extension of disease. Previous reports demonstrate poor accuracy of CE, with the most common discrepancy being failure to identify parametrial involvement (PI). The goal of this study is to determine the accuracy of CE in comparison to final pathology (FP) in early operable CC. Methods: This is a multi-center retrospective review of patients with early CC (FIGO stage IB1, IIA1). Data on age, race, histology, stage, CE findings, FP report and receipt of adjuvant radiation therapy (RT) were collected. CE findings included TS, PI and vaginal involvement (VI). CE of TS, PI, and VI were compared to FP. Subanalysis was also conducted based on TS ( < or ≥ 2cm) and location of tumor (exophytic vs endophytic). Analysis was performed using paired-T and Cohen’s Kappa tests. Results: Final analysis included 135 patients. Mean age was 52.6 years. The majority of patients had squamous cell carcinoma (72.6%). Overall, there was a significant difference between CE of TS compared to FP; mean error of 1.22 cm (p < 0.0001). In those with tumors ≥ 2cm the mean error was 1.28 cm (p < 0.0001). No significant discrepancy was observed in tumors < 2 cm (mean error: 1.10cm; p = 0.5). CE of TS of endophytic tumors was poor (mean error 1.68cm; p = 0.004) compared to exophytic tumors (mean error: 1.12 cm; p = 0.693). There was no significant difference in the identification of VI between CE and FP (3.7% vs 8.89%; p = 0.067). No patients with PI on CE were included in this analysis. However, 14.07% of patients were found to have PI on FP (p < 0.0001). There was no difference in the accuracy CE of TS between non-obese ( < 30 kg/m2) and obese patients (≥30 kg/m2), mean error 1.13 and 1.3, respectively (p = 0.061). As a results of FP, 55 patients (40.7%) received adjuvant RT and 38 patients (28.14%) were upstaged from IB1 to IB2. Of these 38 patients, 36 (94.7%) went on to receive adjuvant RT. Conclusions: CE of TS and PI is inaccurate, especially in tumors ≥ 2cm and endophytic tumors. This suggests imaging should be strongly encouraged, particularly in the setting of the updated FIGO 2018 staging system and recent debate over surgical approach.

scholarly journals Clinically Significant Discrepancy between Clinical and Pathologic Stage of Early Operable Cervical Cancer

2020 ◽  
pp. 1-5
Author(s):  
Jennifer McEachron ◽  
Constantine Gorelick ◽  
Jennifer McEachron ◽  
Katherine Economos ◽  
Margaux J. Kanis ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Final Analysis ◽  
Obese Patients ◽  
Significant Discrepancy ◽  
Local Extension ◽  
Mean Error ◽  
Parametrial Invasion ◽  
Significant Difference ◽  
The Mean ◽  
Clinically Significant

Objectives: The cornerstone of the management of cervical cancer (CC) traditionally relies on clinical examination (CE) of tumor size (TS) and local extension of disease. The goal of this study is to determine the accuracy of CE in comparison to final pathology (FP) in early operable CC. Methods: This is a multi-center retrospective review of patients with early CC (FIGO 2009 Stage IB1, IIA1). CE of TS, parametrial invasion (PI), and vaginal involvement (VI) were compared to FP. Results: The final analysis included 135 patients. Overall, there was a significant difference between CE of TS compared to FP; mean error of 1.22 cm (p<0.0001). In tumors  2cm the mean error was 1.28 cm (p<0.0001). No significant discrepancy was observed in tumors <2 cm (mean error: 1.10cm; p=0.5). CE of TS of endophytic tumors was poor (mean error 1.68cm; p=0.004) compared to exophytic tumors (mean error: 1.12 cm; p=0.693). There was no significant difference in the identification of VI between CE and FP (3.7% vs. 8.89%; p=0.067). 14.07% of patients were found to have PI on FP (p<0.0001). There was no difference in the accuracy CE of TS between non-obese (<30 kg/m2 ) and obese patients (30 kg/m2 ) (p=0.061). As a result of FP, 55 patients (40.7%) received adjuvant RT and 38 patients (28.14%) were upstaged from IB1 to IB2. Conclusion: CE of TS and PI is inaccurate, especially in tumors  2cm and

scholarly journals Pretreatment risk factors for parametrial involvement in FIGO stage IB1 cervical cancer

2015 ◽  
Vol 26 (4) ◽  
pp. 255 ◽  
Author(s):  
Hiroyuki Yamazaki ◽  
Yukiharu Todo ◽  
Kazuhira Okamoto ◽  
Katsushige Yamashiro ◽  
Hidenori Kato
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Figo Stage ◽  
Parametrial Involvement

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB–IIA Cervical Cancer

2017 ◽  
Vol 27 (8) ◽  
pp. 1722-1728 ◽  
Author(s):  
Emel Canaz ◽  
Eser Sefik Ozyurek ◽  
Baki Erdem ◽  
Merve Aldikactioglu Talmac ◽  
Ipek Yildiz Ozaydin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
Figo Stage ◽  
Stage Ib ◽  
Parametrial Involvement

scholarly journals Postoperative Adjuvant Chemotherapy in Locally Advanced Cervical Cancer Patients with Optimal Response to Neoadjuvant Chemotherapy: A Retrospective Study

2020 ◽  
Author(s):  
Xiaojie Feng ◽  
Hongmin Chen ◽  
Lei Li ◽  
Ling Gao ◽  
Xupeng Bai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Figo Stage ◽  
Optimal Number ◽  
Chinese Patients ◽  
Optimal Response ◽  
Increased Risk ◽  
Significant Difference

Abstract Background. Few studies investigated the effectiveness of adjuvant chemotherapy (CT) in patients with optimal response to neoadjuvant CT (NACT), and an optimal number of treatment cycles for these patients remains unknown. Methods. A total of 261 Chinese patients with FIGO stage Ib2–IIb cervical cancer who showed an optimal response to NACT were included after radical surgery (RS), and the disease-free survival (DFS) and overall survival (OS) of patients treated with different cycles of postoperative adjuvant CT were compared. Results. We found that patients treated with different cycles of postoperative adjuvant CT were significantly better than those without further therapy. The multivariate analysis showed that postoperative adjuvant CT was an independent prognostic factor for DFS. However, there was no significant difference in the DFS and OS between patients who had 3 cycles of adjuvant CT and those with 6 cycles. Further analysis revealed a significant association of 6 cycles of adjuvant CT with increased risk of leukopenia, nausea/vomiting, and rash. Conclusion. These data suggest that additional 3 cycles of adjuvant CT after NACT + RS may improve the clinical outcome of optimal responders in terms of DFS, OS, and drug toxicity.

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 Nomogram prediction for overall survival of patients diagnosed with cervical cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5111-5111
Author(s):  
Christoph Grimm ◽  
Alexander Reinthaller ◽  
Gerda Hofstetter ◽  
Nicole Concin ◽  
Christian Marth ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Overall Survival ◽  
Figo Stage ◽  
Bootstrap Sample ◽  
Histologic Subtype ◽  
Prognostic Parameter ◽  
Correction Technique ◽  
Parametrial Involvement ◽  
Node Ratio ◽  
Stage Ia

5111 Background: Cervical cancer is clinically staged based upon the International Federation of Gynecologists and Obstetricians (FIGO) system. FIGO stage is well established as prognostic parameter. It is well known that other additional parameters are useful to estimate overall survival (OS) in patients with cervical cancer. The aim of this multi-center was to create a nomogram to predict OS in patients diagnosed with cervical cancer. Methods: Cervical cancer databases of two large Austrian institutions were analysed. Characteristics known to predict OS were collected. For each patient association between each prognostic parameter and OS was assessed by multivariable modeling. The corresponding 3-year and 5-year OS probabilities were then determined using the nomogram. The constructed nomogram was then validated using the bootstrap correction technique. Results: Mean 5-year OS rates for patients with FIGO stage IA, IB, II, III, and IV were 99.0% (1.0), 88.6% (3.0), 65.8% (5.2), 58.7% (11.0), and 41.5% (14.7), respectively (p<0.001). Mean five-year OS time was 44.2 (30.9) months. Based on the multivariable model FIGO stage, tumor size, age, histologic subtype, lymph node ratio, and parametrial involvement were identified as nomogram parameters. The bootstrap sample corrections provided an estimated concordance probability (interquartile range) of 0.794 (0.779-0.805). Conclusions: Based on 6 easily available parameters a novel nomogram to predict 3-year and 5-year OS of patients diagnosed with cervical cancer was constructed and internally validated. Application of this nomogram allows more accurate and individual prediction of patients’ prognosis.

Selecting cases for feedback to pre-hospital clinicians – a pilot study

2016 ◽  
Vol 40 (3) ◽  
pp. 306 ◽  
Author(s):  
Lisa Brichko ◽  
Paul Jennings ◽  
Christopher Bain ◽  
Karen Smith ◽  
Biswadev Mitra
Keyword(s):  
Patient Care ◽  
Significant Proportion ◽  
Hospital Patient ◽  
Kappa Score ◽  
Significant Discrepancy ◽  
Healthcare Facilities ◽  
Case Identification ◽  
Significant Difference ◽  
Clinically Significant ◽  
Scale Category

Background There are currently limited avenues for routine feedback from hospitals to pre-hospital clinicians aimed at improvements in clinical practice. Objective The aim of this study was to pilot a method for selectively identifying cases where there was a clinically significant difference between the pre-hospital and in-hospital diagnoses that could have led to a difference in pre-hospital patient care. Methods This was a single-centre retrospective study involving cases randomly selected through informatics extraction of final diagnoses at hospital discharge. Additional data on demographics, triage and diagnoses were extracted by explicit chart review. Blinded groups of pre-hospital and in-hospital clinicians assessed data to detect clinically significant differences between pre-hospital and in-hospital diagnoses. Results Most (96.9%) patients were of Australasian Triage Scale category 1–3 and in-hospital mortality rate was 32.9%. Of 353 cases, 32 (9.1%; 95% CI: 6.1–12.1) were determined by both groups of clinical assessors to have a clinically significant difference between the pre-hospital and final in-hospital diagnoses, with moderate inter-rater reliability (kappa score 0.6, 95% CI: 0.5–0.7). Conclusion A modest proportion of cases demonstrated discordance between the pre-hospital and in-hospital diagnoses. Selective case identification and feedback to pre-hospital services using a combination of informatics extraction and clinician consensus approach can be used to promote ongoing improvements to pre-hospital patient care. What is known about the topic? Highly trained pre-hospital clinicians perform patient assessments and early interventions while transporting patients to healthcare facilities for ongoing management. Feedback is necessary to allow for continual improvements; however, the provision of formal selective feedback regarding diagnostic accuracy from hospitals to pre-hospital clinicians is currently not routine. What does this paper add? For a significant proportion of patients, there is a clinically important difference in the diagnosis recorded by their pre-hospital clinician compared with their final in-hospital diagnosis. These clinically significant differences in diagnoses between pre-hospital and in-hospital clinicians were most notable among acute myocardial infarction and trauma subgroups of patients in this study. What are the implications for practitioners? Identification of patients who have a significant discrepancy between their pre-hospital and in-hospital diagnoses could lead to the development of feedback mechanisms to pre-hospital clinicians. Providing pre-hospital clinicians with this selective feedback would be intended to promote ongoing improvements in pre-hospital assessments and thereby to improve service delivery.

Revised FIGO staging shows dramatic survival differences in cervical cancer patients with positive lymph nodes in Louisiana.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17010-e17010
Author(s):  
Navya Nair ◽  
Lu Zhang ◽  
Anna Kuan-Celarier ◽  
Xiao-cheng Wu ◽  
Amelia Jernigan
Keyword(s):  
Cervical Cancer ◽  
Staging System ◽  
Figo Stage ◽  
Stage I ◽  
Stage Iii ◽  
Poverty Level ◽  
Stage Iiic ◽  
Figo Staging ◽  
Survival Differences

e17010 Background: With revisions to FIGO cervical cancer staging system in 2018, patients with positive pelvic or para-aortic lymph nodes (LN) are now classified as stage IIIC. Rationale for this change is based on data published in 1990. Methods for work up and treatment of cervical cancer have advanced since then. We aim to determine if updated FIGO staging reflects contemporary survival differences in women with cervical cancer in Louisiana. Methods: Women with FIGO stage I-III cervical cancer diagnosed between 2010 and 2016 were identified from the Louisiana Tumor Registry. Those with < 30 days follow up were excluded. Patients were classified into 3 groups: true stage I & II (LN negative), revised stage IIIC (old stage I or II but positive LN), previous stage III (old FIGO stage IIIA or IIIB). Cox proportional hazards were used to estimate differences in overall and (OS) cause-specific survival (CSS). Covariates of age, race, insurance, census-tract poverty level, and marital status were controlled. Results: 740 patients were included with a median follow up of 40.6 months. Patients in revised stage IIIC group were younger than the others (45.9 yrs vs 47.9 yrs in true stage I&II vs 55yrs in previous stage III, p < 0.0001). True stage I&II patients were more likely to be privately insured (48.9% vs 32.1% revised stage IIIC vs 27.7% previous stage III, p < 0.0001). The groups did not differ by race, poverty level, or marital status. Revised stage IIIC and previous stage III patients had significantly worse survival outcomes compared to true stage I & II in both OS [revised stage IIIC HR 1.93 (1.20-3.11); previous stage III 5.92 (4.27, 8.22)] and CSS [revised stage IIIC HR 2.54 (1.45-4.44); previous stage III HR 7.95 (5.29, 11.94)]. Kaplan-Meier survival curves demonstrate significant differences in both OS and CSS (p < 0.0001) with best outcomes in true stage I&II and worst in previous stage III patients. Conclusions: LN status is an important prognostic indicator for contemporary cervical cancer patients in Louisiana. This analysis provides recent data to support the revised FIGO staging system in upstaging patients with positive LN to stage IIIC as they have significantly worse survival than the true stage I & II patients. Importantly, revised stage IIIC patients who would have previously been stage I & II have strikingly better survival outcomes than women with stage IIIA and IIIB disease. If staging is to be intuitive, the stage III subcategories may need to be redefined.

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