Fatma SERT, Senem ALANYALI, Zeynep ÖZSARAN, Beril BALCI

Comparison of The International Federation of Gynecology and Obstetrics (FIGO) 2018 and 2009 Staging Systems for Operated Cervical Carcinoma

OBJECTIVE The purpose of the study was to compare FIGO 2009 and 2018 uterine cervical carcinoma staging systems in terms of patient distribution and efficacy in predicting treatment outcome in patients treated with surgery and adjuvant radiotherapy (RT)+/−concomitant chemotherapy (CT). METHODS The records of 184 uterine cervical cancer patients treated with post-operative RT/RCT from 2007 to 2017 were retrospectively reviewed. Surgical procedure was in the form of Wertheim surgery in 96 patients (52%) and pelvic lymph node dissection was performed in 32 patients (17.5%). One hundred and sixty-six patients (87.5%) received both external RT and intracavitary brachytherapy, and 23 (12.5%) patients were treated only with external RT. RESULTS The median follow-up time was 61.5 months (range, 8-132 moths). One hundred and fifty-one (82%) patients were alive, and 144 (94%) of these were free of disease at the time of this analysis. The median time for locoregional failure and distant metastasis were 25 months (range, 8-88 months) and 38 months (range, 12-118 months). Stage migration was recorded in 130 patients (70.7%) in our series when the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system was used. The most remarkable stage migration was detected for Stage I patients. A total of 119 (64.6%) patients with Stage I showed stage migration. Five-year locoregional control, disease-free survival, disease-specific survival, and overall survival rates were 91%, 88%, 91%, and 83%, respectively. CONCLUSION The updated FIGO staging system for invasive cervical cancer incorporates imaging and pathological findings. Our results suggest us that the major improvement of 2018 staging system for uterine cervical carcinoma is that it produced better discrimination in terms of survival outcome in patients with lymph node metastases both pelvic and para-aortic.

PDF

___

1. Lee SI, Atri M. 2018 FIGO staging system for uterine cervical cancer: Enter cross-sectional imaging. Radiology 2019;292(1):15–24.
2. Bhatla N, Berek J, Cuello M. Abstract of the FIGO XXII world congress of gynecology and obstetrics. Int J Gynecol Obstet 2018;143(3):43–991.
3. Amendola MA, Hricak H, Mitchell DG, Snyder B, Chi DS, Long HJ III, et al. Utilization of diagnostic studies in the pretreatment evaluation of invasive cervical cancer in the United States: Results of intergroup protocol ACRIN 6651/GOG 183. J Clin Oncol 2005;23(30):7454–9.
4. Van Nagell JR Jr., Roddick JW Jr., Lowin DM. The staging of cervical cancer: Inevitable discrepancies between clinical staging and pathologic findinges. Am J Obstet Gynecol 1971;110(7):973–8.
5. Mayr NA, Yuh WT, Zheng J, Ehrhardt JC, Sorosky JI, Magnotta VA, et al. Tumor size evaluated by pelvic examination compared with 3-D quantitative analysis in the prediction of outcome for cervical cancer. Int J Radiat Oncol Biol Phys 1997;39(2):395–404.
6. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynecol Obstet 2018;143(2):22–36.
7. Berek JS, Matsuo K, Grubbs BH, Gaffney DK, Lee SI, Kilcoyne A, et al. Multidisciplinary perspectives on newly revised 2018 FIGO staging of cancer of the cervix uteri. J Gynecol Oncol 2019;30(2):e40.
8. Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012 v1.0. Lyon, France: International Agency for Research on Cancer; 2013.
9. Sankaranarayanan R. Screening for cancer in lowand middle-income countries. Ann Glob Health 2014;80(5):412–7.
10. Sahdev A, Sohaib SA, Wenaden AE, Shepherd JH, Reznek RH. The performance of magnetic resonance imaging in early cervical carcinoma: A long-term experience. Int J Gynecol Cancer 2007;17(3):629–36.
11. Matsuo K, Machida H, Mandelbaum RS, Konishi I, Mikami M. Validation of the 2018 FIGO cervical cancer staging system. Gynecol Oncol 2019;152(1):87–93.
12. Kidd EA, Siegel BA, Dehdashti F, Rader JS, Mutch DG, Powell MA, et al. Lymph node staging by positron emission tomography in cervical cancer: Relationship to prognosis. J Clin Oncol 2010;28(12):2108–13.
13. Zighelboim I, Taylor NP, Powell MA, Gibb RK, Rader JS, Mutch DG, et al. Outcomes in 24 selected patients with stage IVB cervical cancer and excellent performance status treated with radiotherapy and chemotherapy. Radiat Med 2006;24(9):625–30.