From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups?

Sara Elisabeth Sponholtz; Ole Mogensen; Malene Grubbe Hildebrandt; Doris Schledermann; Erik Parner; Algirdas Markauskas; Ligita Paskeviciute Frøding; Katrine Fuglsang; Jorun Holm; Sarah Marie Bjørnholt; Pernille Tine Jensen

doi:10.1016/j.ygyno.2021.08.026

From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups?

Sara Elisabeth Sponholtz^*, Ole Mogensen, Malene Grubbe Hildebrandt, Doris Schledermann, Erik Parner, Algirdas Markauskas, Ligita Paskeviciute Frøding, Katrine Fuglsang, Jorun Holm, Sarah Marie Bjørnholt, Pernille Tine Jensen

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Abstract

Objectives: We aimed to evaluate if the revised staging according to FIGO-2018 in early-stage cervical cancer correctly predicts the risk for nodal metastases. Methods: We reallocated 245 women with early-stage cervical cancer from FIGO-2009 to FIGO-2018 stages using data from a national, prospective cohort study on sentinel lymph node (SLN) mapping. We used univariate and multivariate binary regression models to investigate the association between FIGO-2018 stages, tumor characteristics, and nodal metastases. Results: Stage migration occurred in 54.7% (134/245) (95% CI 48.2–61.0), due to tumor size or depth of invasion (71.6%, 96/134) and nodal metastases (28.4%, 38/134). Imaging preoperatively upstaged 7.3% (18/245); seven had nodal metastatic disease on final pathology. Upstaging occurred in 49.8% (122/245) (95% CI 43.4–56.2%) and downstaging to FIGO-2018 IA stages in 4.9% (12/245) (95% CI 2.6–8.4). The tumor size ranged from 3.0–19.0 mm in women with FIGO-2018 IA tumor characteristics, and none of the 14 women had nodal metastases. In multivariate analysis, risk factors significantly associated with nodal metastases were FIGO-2018 ≥ IB2 (RR 5.01, 95% CI 2.30–10.93, p < 0.001), proportionate depth of invasion >2/3 (RR 1.88, 95% CI 1.05–3.35, p = 0.033), and lymphovascular space invasion (RR 5.56, 95% CI 2.92–10.62, p < 0.001). Conclusions: The FIGO-2018 revised staging system causes stage migration for a large proportion of women with early-stage cervical cancer. Women who were downstaged to FIGO-2018 IA stages did not have nodal metastatic disease. The attention on depth of invasion rather than horizontal dimension seems to correctly reflect the risk of nodal metastases.

Originalsprog	Engelsk
Tidsskrift	Gynecologic Oncology
Vol/bind	163
Udgave nummer	2
Sider (fra-til)	281-288
ISSN	0090-8258
DOI	https://doi.org/10.1016/j.ygyno.2021.08.026
Status	Udgivet - nov. 2021

Bibliografisk note

Funding Information:
The project was funded by the University of Southern Denmark , Odense University Hospital , The Danish Cancer Society , The Danish Cancer Research Foundation , The Senior Consultant Research Council Odense University Hospital Denmark , Copenhagen University Hospital , Carpenter Axel Kastrup-Nielsen's Memorial Fund , Eva and Henry Fraenkel's Memorial Mund , King Christian the 10th's Fund , and Frimodt-Heineke's Fund . The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation; review, or approval of the manuscript; and decision to submit the manuscript for publication.

Dokumenter og links

10.1016/j.ygyno.2021.08.026Licens: CC BY

Open Access VersionForlagets udgivne version, 695 KBLicens: CC BY

1 Ph.d.-afhandling

Sentinel node mapping with robotic assisted NIR fluorescent imaging and ICG in women with cervical cancer: SENTIREC CERVIX
Bidragets oversatte titel: Robot-assisteret skildvagtlymfeknude kortlægning med fluorescerende NIR billeddannelse og ICG hos kvinder med cervix cancer: SENTIREC CERVIXHaugaard, S. S., 13. dec. 2021, Syddansk Universitet. Det Sundhedsvidenskabelige Fakultet. 215 s.
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Citationsformater

Sponholtz, S. E., Mogensen, O., Hildebrandt, M. G., Schledermann, D., Parner, E., Markauskas, A., Frøding, L. P., Fuglsang, K., Holm, J., Bjørnholt, S. M., & Jensen, P. T. (2021). From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups? Gynecologic Oncology, 163(2), 281-288. https://doi.org/10.1016/j.ygyno.2021.08.026

@article{ed7fd61acfb6422ea7b6053670ade6a9,

title = "From FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; Does the revised staging reflect risk groups?",

abstract = "Objectives: We aimed to evaluate if the revised staging according to FIGO-2018 in early-stage cervical cancer correctly predicts the risk for nodal metastases. Methods: We reallocated 245 women with early-stage cervical cancer from FIGO-2009 to FIGO-2018 stages using data from a national, prospective cohort study on sentinel lymph node (SLN) mapping. We used univariate and multivariate binary regression models to investigate the association between FIGO-2018 stages, tumor characteristics, and nodal metastases. Results: Stage migration occurred in 54.7% (134/245) (95% CI 48.2–61.0), due to tumor size or depth of invasion (71.6%, 96/134) and nodal metastases (28.4%, 38/134). Imaging preoperatively upstaged 7.3% (18/245); seven had nodal metastatic disease on final pathology. Upstaging occurred in 49.8% (122/245) (95% CI 43.4–56.2%) and downstaging to FIGO-2018 IA stages in 4.9% (12/245) (95% CI 2.6–8.4). The tumor size ranged from 3.0–19.0 mm in women with FIGO-2018 IA tumor characteristics, and none of the 14 women had nodal metastases. In multivariate analysis, risk factors significantly associated with nodal metastases were FIGO-2018 ≥ IB2 (RR 5.01, 95% CI 2.30–10.93, p < 0.001), proportionate depth of invasion >2/3 (RR 1.88, 95% CI 1.05–3.35, p = 0.033), and lymphovascular space invasion (RR 5.56, 95% CI 2.92–10.62, p < 0.001). Conclusions: The FIGO-2018 revised staging system causes stage migration for a large proportion of women with early-stage cervical cancer. Women who were downstaged to FIGO-2018 IA stages did not have nodal metastatic disease. The attention on depth of invasion rather than horizontal dimension seems to correctly reflect the risk of nodal metastases.",

keywords = "Cervical cancer, FDG-PET/CT imaging, FIGO-2018 staging, Lymph node metastases, Minimally invasive surgery, Sentinel lymph node mapping",

author = "Sponholtz, {Sara Elisabeth} and Ole Mogensen and Hildebrandt, {Malene Grubbe} and Doris Schledermann and Erik Parner and Algirdas Markauskas and Fr{\o}ding, {Ligita Paskeviciute} and Katrine Fuglsang and Jorun Holm and Bj{\o}rnholt, {Sarah Marie} and Jensen, {Pernille Tine}",

note = "Funding Information: The project was funded by the University of Southern Denmark , Odense University Hospital , The Danish Cancer Society , The Danish Cancer Research Foundation , The Senior Consultant Research Council Odense University Hospital Denmark , Copenhagen University Hospital , Carpenter Axel Kastrup-Nielsen's Memorial Fund , Eva and Henry Fraenkel's Memorial Mund , King Christian the 10th's Fund , and Frimodt-Heineke's Fund . The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation; review, or approval of the manuscript; and decision to submit the manuscript for publication.",

year = "2021",

month = nov,

doi = "10.1016/j.ygyno.2021.08.026",

language = "English",

volume = "163",

pages = "281--288",

journal = "Gynecologic Oncology",

issn = "0090-8258",

publisher = "Academic Press",