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

Abstract

To validate the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system for cervical cancer on the survival of patients who underwent radical hysterectomy for 2009 FIGO stage IB carcinomas. We retrospectively identified and reviewed 251 patients treated with radical hysterectomy for 2009 FIGO stage IB cervical carcinomas from January 2011 to December 2016. The re-staged IB cohort consisted of 2018 FIGO stage IB1 (tumor size <2 cm), IB2 (2–3.9 cm), IB3 (≥4 cm), and IIIC1p (any pelvic nodal metastasis) cervical cancer. The univariate log-rank test and multivariate Cox regression models were performed for all potential clinic pathological risk factors based on cancer stage. On re-staging the 251 patients with 2009 FIGO stage IB using the 2018 FIGO staging system, 96 patients (38.2%) had stage IB1, 109 patients (43.4%) had stage IB2, 28 patients (11.2%) had stage IB3, and 18 patients (7.2%) had stage IIIC1p. The 5-year overall survival (OS) rates of patients with 2018 FIGO stage IB1, IB2, IB3, and IIIC1p were 97.9%, 92.7%, 78.6%, and 61.1%, respectively. The 5-year progression-free survival rates were 97.9%, 92.7%,63.7%, and 20.8%, respectively. Factors significantly affecting OS and disease-free survival were 2018 FIGO stage≥IB3, histologic grade 2–3, and lymph node involvement. The revised 2018 FIGO staging system seemed to accurately reflect the survival rate, with a distinct statistical tendency for poorer 5-year disease-free survival and OS rates with increasing stage. Women with positive lymph nodes in this classification were classified as having stage IIIC disease, which can achieve more realistic survival results than the previous staging system. The prognostic discrimination of histologic grade should be considered when revising the staging system in the future.

Stage Migration in Cervical Cancer Using the FIGO 2018 Staging System: A Retrospective Survival Analysis Using a Single-Institution Patient Cohort

“…In this particular study, restaging using the FIGO 2018 staging system revealed an estimated 13% and 28% stage migration for Stage IB3 and Stage IIIC, respectively [ 11 ]. In an analysis of 251 cervical cancer patients conducted by Zeng et al, restaging the patients using the 2018 FIGO system resulted in an 11.2% and 7.2% stage migration for Stage IB3 and Stage IIIC, respectively [ 12 ]. Grigsby et al reported that 53% of patients had stage migration when the FIGO 2018 system was used [ 13 ].…”

“…The previously mentioned Yan et al analysis found the FIGO 2018 stage to be an independent prognostic factor for OS [ 12 ]. In the Zeng et al study mentioned before, the five-year progression-free survival rates showed the same trend with increasing stage reflecting upon the revised 2018 FIGO staging system's effectiveness in predicting outcomes [ 12 ].…”

“…The previously mentioned Yan et al analysis found the FIGO 2018 stage to be an independent prognostic factor for OS [ 12 ]. In the Zeng et al study mentioned before, the five-year progression-free survival rates showed the same trend with increasing stage reflecting upon the revised 2018 FIGO staging system's effectiveness in predicting outcomes [ 12 ]. On the other hand, in a retrospective study of 425 cervical cancer patients conducted by Ayhan et al, there were no significant differences in the five-year OS rates within the various sub-stages of IB disease [ 21 ].…”

Number of lymph node in early-stage cervical cancer after radical surgery, does it matter?

“…Lymph node status is one of the important prognostic factors in early-stage cervical cancer patients underwent RHPL [4,7]. The DFS and OS were significantly different between the patients with and without MLN [18,19]. The number of MLN is associated with survival.…”

An exploratory study of the dose correlation between point B and metastatic lymph nodes in three‐dimensional high‐dose‐rate brachytherapy for cervical cancer

“…Thirty patients with cervical cancer with lymph node metastases who received radiotherapy at Liaoning Cancer Hospital and Institute from May 2019 to November 2020 were selected and their data retrospectively analyzed. According to the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging criteria for cervical cancer, all patients were staged as IIIC1r, IIIC2r, IVA, and IVB with lymph node metastases, and were pathologically diagnosed with squamous cell carcinoma, adenocarcinoma, and others 4 . A short diameter >8 mm was consistent with metastatic lymph nodes according to imaging data from patients before treatment: a total of 78 lymph nodes were included in the study 5 .…”