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

*Corresponding author for this work

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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.

Original languageEnglish
JournalGynecologic Oncology
Issue number2
Pages (from-to)281-288
Publication statusPublished - Nov 2021


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


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