Does the New FIGO 2018 Staging System Allow Better Prognostic Differentiation in Early Stage Cervical Cancer? A Dutch Nationwide Cohort Study

Mieke L G Ten Eikelder*, Floor Hinten, Anke Smits, Maaike A Van der Aa, Ruud L M Bekkers, Joanna IntHout, Hans H B Wenzel, Petra L M Zusterzeel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The FIGO 2018 staging system was introduced to allow better prognostic differentiation in cervical cancer, causing considerable stage migration and affecting treatment options. We evaluated the accuracy of the FIGO 2018 staging in predicting recurrence free (RFS) and overall survival (OS) compared to FIGO 2009 staging in clinically early stage cervical cancer. We conducted a nationwide retrospective cohort study, including 2264 patients with preoperative FIGO (2009) IA1, IA2 and IB1 cervical cancer between 2007-2017. Kaplan-Meier analyses were used to assess survival outcomes. Logistic regression was used to assess risk factors for lymph node metastasis and parametrial invasion. Stage migration occurred in 48% (22% down-staged, 26% up-staged). Survival data of patients down-staged from IB to IA1/2 disease were comparable with FIGO 2009 IA1/2 and better than patients remaining stage IB1. LVSI, invasion depth and parametrial invasion were risk factors for lymph node metastases. LVSI, grade and age were associated with parametrial invasion. In conclusion, the FIGO 2018 staging system accurately reflects prognosis in early stage cervical cancer and is therefore more suitable than the FIGO 2009 staging. However subdivision in IA1 or IA2 based on presence or absence of LVSI instead of depth of invasion would have improved accuracy. For patients down-staged to IA1/2, less radical surgery seems appropriate, although LVSI and histology should be considered when determining the treatment plan.

Original languageEnglish
Article number3140
Number of pages13
JournalCancers
Volume14
Issue number13
DOIs
Publication statusPublished - 27 Jun 2022

Keywords

  • CARCINOMA
  • FIGO staging 2018
  • IA2
  • IB
  • IIA
  • LYMPHADENECTOMY
  • METASTASES
  • PARAMETRIAL INVOLVEMENT
  • RADICAL HYSTERECTOMY
  • SPACE INVASION
  • WOMEN
  • early-stage cervical cancer
  • overall survival
  • recurrence free survival
  • risk factors

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