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

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.

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Efficacy of different surgical approaches on survival outcomes in patients with early-stage cervical cancer: protocol for a multicentre longitudinal study in China

BMJ Open ◽

10.1136/bmjopen-2020-038020 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038020

Author(s):

Xiaopei Chao ◽

Ming Wu ◽

Shuiqing Ma ◽

Xianjie Tan ◽

Sen Zhong ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Early Stage ◽

Disease Free Survival ◽

Learning Curves ◽

Surgical Approaches ◽

Survival Outcomes ◽

Link Type ◽

Gynecology And Obstetrics ◽

Early Stage Cervical Cancer

IntroductionRecent studies have revealed that the oncological survival outcomes of minimally invasive radical hysterectomy (MIRH) are inferior to those of abdominal radical hysterectomy (ARH) in early-stage cervical cancer, but the potential reasons are unclear.Methods and analysisEach expert from 28 study centres participating in a previously reported randomised controlled trial (NCT03739944) will provide successive eligible records of at least 100 patients who accepted radical hysterectomy for early-stage cervical cancer between 1 January 2009 and 31 December 2015. Inclusion criteria consist of a definite pathological evaluation of stages IA1 (with positive lymphovascular space invasion), IA2 and IB1 according to the International Federation of Gynecology and Obstetrics 2009 staging system and a histological subtype of squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma. The primary endpoint is 5-year disease-free survival between the MIRH and ARH groups. The secondary endpoints include the MIRH learning curves of participating surgeons, 5-year overall survival between the MIRH and ARH groups, survival outcomes according to surgical chronology, surgical outcomes and sites of recurrence and potential risk factors that affect survival outcomes. A subgroup analysis in patients with tumour diameter less than 2 cm will follow the similar flow diagram.Ethics and disseminationThis study has been approved by the Institutional Review Board of Peking Union Medical College Hospital (registration no. JS-1711), and is also filed on record by all other 27 centres. The results will be disseminated through community events and peer-reviewed journals.Trial registration numberNCT03738969

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Should the Number of Metastatic Pelvic Lymph Nodes Be Integrated into the 2018 Figo Staging Classification of Early Stage Cervical Cancer?

Cancers ◽

10.3390/cancers12061552 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1552

Author(s):

Luigi Pedone Anchora ◽

Vittoria Carbone ◽

Valerio Gallotta ◽

Francesco Fanfani ◽

Francesco Cosentino ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Nodes ◽

Early Stage ◽

Disease Free Survival ◽

Staging System ◽

Lymph Node Status ◽

P Value ◽

Pelvic Lymph Nodes ◽

Early Stage Cervical Cancer ◽

The Impact

Introduction: Lymph node status has become part of the new staging system for cervical cancer (CC). It has been shown that patients staged as IIIC1 had heterogeneous prognoses and, in some cases, experienced better outcomes than patients with lower stages. We evaluated the impact of the number of metastatic pelvic lymph nodes (MPLNs) among patients with stage IIIC1 cervical cancer. Methods: Survival analyses were conducted in order to identify the best cut-off prognostic value relative to the number of MPLNs. Disease free survival (DFS) was considered the main outcome. Results: 541 patients were included in the study. Eighty-nine patients were of stage IIIC1. The best prognostic cut-off value of the number of MPLNs was 2. Patients with >2 MPLNs (n > 2 group) had worse DFS compared with those having <2 (N1-2 group) (5 yr DFS: 54.7% vs. 78.1%, p value = 0.006). Multivariate analyses demonstrated that the extent of MPLNs had little impact on DFS and that replacement of IIIC1 staging with N1-2 and n > 2 grouping provided a better, statistically significant model (p value = 0.006). Discussion: Using a cut-off value of 2, the number of MPLNs could better predict prognostic outcomes within stage IIIC1 cervical cancer and have potential implications for therapeutic decision-making in the treatment of patients with stage IIIC1 CC.

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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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Oncologic and obstetric outcomes after simple conization for fertility-sparing surgery in FIGO 2018 stage IB1 cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001750 ◽

2021 ◽

Vol 31 (3) ◽

pp. 452-456

Author(s):

Francesco Fanfani ◽

Luigi Pedone Anchora ◽

Giampaolo Di Martino ◽

Nicolò Bizzarri ◽

Maria Letizia Di Meo ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Nodes ◽

Early Stage ◽

Fetal Loss ◽

Disease Free Survival ◽

Figo Stage ◽

Oncologic Outcomes ◽

Obstetric Outcomes ◽

Gynecology And Obstetrics ◽

Fertility Sparing

ObjectiveConization/simple trachelectomy is feasible in patients with early-stage cervical cancer. Retrospective data suggest that conization with negative lymph nodes could be a safe option for these patients. This study aims to provide oncologic and obstetric outcomes of a large series of patients with 2018 International Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical cancer managed by conization.MethodsPatients with early cervical cancer and a desire to preserve fertility who underwent conization and pelvic lymphadenectomy from January 1993 to December 2019 in two Italian centers were included. Inclusion criteria were: age >18 years and ≤45 years, 2018 FIGO stage IB1, no prior irradiation or chemotherapy, absence of pre-operative radiologic evidence of nodal metastases, a strong desire to preserve fertility, and absence of concomitant malignancies. We excluded patients with confirmed infertility, neuroendocrine tumor, clear cell or mucinous carcinoma.ResultsA total of 42 patients were included. The median age was 32 years (range 19–44) and median tumor size was 11 mm (range 8–20). Squamous cell carcinoma was found in 27 (64.3%). Grade 3 tumor was present in 7 (16.7%) patients and lymphovascular space involvement was detected in 15 (35.7%). At a median follow-up of 54 months (range 1–185), all patients were alive without evidence of disease. In the entire series three patients experienced recurrence resulting in an overall recurrence rate of 7.1%. All the recurrences occurred in the pelvis (2 in the cervix and 1 in the lymph nodes), resulting in a 3-year disease-free survival of 91.6%. Twenty-two (52%) patients tried to conceive; 18 pregnancies occurred in 17 patients and 12 live births were reported (6 pre-term and 6 term pregnancies). Two miscarriages were recorded, one first trimester and one second trimester fetal loss.ConclusionsOur study showed that conization is feasible for the conservative management of women with stage IB1 cervical cancer desiring fertility. Oncologic outcomes appear favorable in this series of patients. Future prospective studies will hopefully provide further insight into this important question.

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Application of Modified Laparoscopic Radical Hysterectomy in The Treatment of Early Cervical Cancer

10.21203/rs.3.rs-219139/v1 ◽

2021 ◽

Author(s):

Xuqing Li ◽

Xueting Pei ◽

Hongyan Li ◽

Yan Wang ◽

Youwei Zhou ◽

...

Keyword(s):

Cervical Cancer ◽

Radical Hysterectomy ◽

Surgical Procedure ◽

Early Stage ◽

Disease Free Survival ◽

Bladder Function ◽

Laparoscopic Radical Hysterectomy ◽

Gynecology And Obstetrics ◽

Normal Bladder ◽

Early Stage Cervical Cancer

Abstract Background: To investigate the safety and efficacy of modified laparoscopic radical hysterectomy (MLRH) in the treatment of early stage cervical cancer by comparing relevant indices of different surgical procedures in patients with early stage cervical cancer.Methods: Patients with 2014 International Federation of Gynecology and Obstetrics (FIGO) clinical stages IB1 and IIA1 cervical cancer who underwent radical hysterectomy in the Gynecological Department of our hospital from October 2015 to June 2018 were enrolled. Patients were divided into two groups based on the surgical procedure: the open radical hysterectomy (ORH) group (n=336) and MLRH group (n=302). We retrospectively analyzed and compared the clinical characteristics, surgical indices, and survival prognosis between the groups.Results: Compared to the ORH group, the MLRH group exhibited a longer operative time, normal bladder function recovery time, less intraoperative blood loss volume, and more harvested pelvic lymph nodes (P<0.05). No significant differences were observed in postoperative complications, the 2.5-year overall survival (OS) rate, 2.5-year disease-free survival (DFS) rate, and recurrence rate between the groups (P>0.05), but the recurrence pattern was significantly different between the groups (P<0.05). Stratified analysis revealed that OS time was shorter in the ORH group than in the MLRH group in patients with stage IB1 and middle invasion (P<0.05). Pathological type was an independent factor for DFS and OS in early stage cervical cancer.Conclusion: MLRH incorporates a series of measures to prevent tumor spillage. It is a feasible and effective surgical procedure for the treatment of early stage cervical cancer.Trial registration: Present research is a retrospective study. The study had retrospectively registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/) and the registered number is ChiCTR1900026306.

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Prognostic value of lymphovascular space invasion in early-stage cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001274 ◽

2020 ◽

Vol 30 (10) ◽

pp. 1493-1499

Author(s):

Ariane Weyl ◽

Claire Illac ◽

Amélie Lusque ◽

Hélène Leray ◽

Charlotte Vaysse ◽

...

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Prognostic Value ◽

Early Stage ◽

Disease Free Survival ◽

External Radiotherapy ◽

Free Survival ◽

Early Stage Cervical Cancer ◽

Disease Free ◽

Lymphovascular Space Invasion

ObjectiveFew prognostic factors likely to influence therapeutic management of early-stage cervical cancer are currently recognized. The objective of this study was to determine the prognostic value of lymphovascular space invasion (LVSI) in overall survival of patients with early-stage cervical cancer.MethodsThis is a retrospective study of patients treated for early-stage cervical cancer between January 1996 and December 2013 at Toulouse University Hospital and the Cancer Center Claudius Regaud Institute. Patients were included if they had FIGO 2018 stage IA1, IA2, IB1/2, or IIA1 cervical cancer. All patients had to have had surgery (conization, radical hysterectomy, or radical trachelectomy). The presence of LVSI was evaluated in the initial anatomic pathology reports of the excised tissue. The presence of LVSI was defined by the presence of epithelial tumor cells in the lumen of vessels, lined by endothelial cells. If the data were missing, the slides were reviewed by an expert pathologist. Comparative analyses of patient populations with and without LVSI invasion were performed, as well as analyses of overall and disease-free survival.ResultsA total of 158 patients were included in the analysis. Seventy-two (45.6%) patients had LVSI. More patients with LVSI received external radiotherapy in addition to standard treatment than patients without LVSI (53% vs 14%, p<0.0001). The overall survival of patients with LVSI (89.8%) was similar to that of patients without LVSI (91.5%) (p=0.39). For patients without lymph node involvement but with LVSI, disease-free survival at 5 years tended to be higher among those treated with external radiotherapy in addition to standard treatments (92.6% vs 79.8%, difference not tested due to the small number of events).ConclusionPatients with early-stage cervical cancer with LVSI received external radiotherapy more often, and therefore had an overall survival at 5 years identical to patients without LVSI.

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Sentinel Lymph-Node Biopsy in Early-Stage Cervical Cancer: The 4-Year Follow-Up Results of the Senticol 2 Trial

Frontiers in Oncology ◽

10.3389/fonc.2020.621518 ◽

2021 ◽

Vol 10 ◽

Author(s):

Guillaume Favre ◽

Benedetta Guani ◽

Vincent Balaya ◽

Laurent Magaud ◽

Fabrice Lecuru ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Early Stage ◽

Disease Free Survival ◽

Lymph Node Biopsy ◽

Free Survival ◽

Early Stage Cervical Cancer ◽

Disease Free

IntroductionSenticol 2 is a randomized multicenter trial in the treatment of early-stage cervical cancer patients. The aim of the Senticol 2 study was to compare the effect of sentinel-lymph-node biopsy (SLNB) to that of SLNB + pelvic lymphadenectomy (PLND), and to determine the postoperative lymphatic morbidity in the two groups. Here, we report a secondary objective of this study: the follow up.Material and MethodsIn the Senticol 2 trial, patients underwent a laparoscopy with a sentinel-node-detection procedure and were randomized into two groups, namely: Group A, in which participants received SLNB, and Group B, in which participants received SLNB + PLND. Patients with an intra-operative macroscopically suspicious lymph node, were given a frozen-section evaluation and were randomized only if the results were negative. All of the patients received follow up with a clinical examination at 1, 3, and 6 months after surgery, and then every 3–4 months after that. The median follow up was 51 months (4 years and 3 months).ResultsDisease-free survival after 4 years for the SLNB group and the SLNB + PLND group were 89.51% and 93.1% (p = 0.53), respectively. The only statistical factor associated with recurrence in the univariate analysis was the adjuvant radiotherapy. No other factors, including the age of the patients, histological type, tumor size, lymph vascular space invasion (LVSI), and positive nodal status, were significant in the univariate or multivariate analyses. The overall survival rates after 4 years in the SLNB and SLNB + PLND groups were 95.2% and 96% (p = 0.97), with five and four deaths, respectively. The univariate and multivariate analyses did not find any prognostic factors.ConclusionsThis randomized study confirmed the results of the Senticol 1 study and supports the sentinel lymph node (SLN) technique as a safe technique for use in patients with early-stage cervical cancer treated with SLNB only. Disease-free survival after 4 years was similar in patients treated with SLN biopsy and patients who underwent a lymphadenectomy.

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IS NODAL RECURRENCE INCREASED AFTER SENTINEL LYMPH NODE BIOPSY IN PATIENTS WITH EARLY-STAGE CERVICAL CANCER ?

10.26226/morressier.599bdc7ad462b80296ca09ed ◽

2017 ◽

Author(s):

Adriano Rodriguez Trujillo

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Sentinel Lymph Node ◽

Sentinel Lymph Node Biopsy ◽

Early Stage ◽

Lymph Node Biopsy ◽

Nodal Recurrence ◽

Node Biopsy ◽

Early Stage Cervical Cancer

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Improving Risk Stratification of Early Oral Tongue Cancer with TNM-Immune (TNM-I) Staging System

Cancers ◽

10.3390/cancers13133235 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3235

Author(s):

Alhadi Almangush ◽

Ibrahim O. Bello ◽

Ilkka Heikkinen ◽

Jaana Hagström ◽

Caj Haglund ◽

...

Keyword(s):

Overall Survival ◽

Tongue Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Tumor Infiltrating Lymphocytes ◽

Staging System ◽

Oral Tongue ◽

Oral Tongue Cancer ◽

Important Player ◽

Infiltrating Lymphocytes

Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors (p > 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92–4.28; p < 0.001); HR of 2.41 (95% CI 1.26–4.60; p = 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13–3.43; p = 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.

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