FIGO 2018 Staging Shifts in Cervical Cancer Patients Who Received Definitive Chemoradiation

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Comparison of outcomes and shifts in stage using the 2018 FIGO cervical cancer staging in patients with known paraaortic lymph node status treated with definitive chemoradiation (CRT) has not been described. Our goal is to report these shifts and outcomes. A single institutional retrospective review was performed on 141 patients with IRB approval who received definitive CRT from 2000-2018. Patient data, including PET/CT or CT for work-up, were used to determine shifts with restaging from the FIGO 2009 to the FIGO 2018 system. Survival was then analyzed using log-rank tests to compare overall survival. Of 141 cervical patients staged per FIGO 2009, 15% (21) and 30.4% (43) were stage II and III, respectively (Table 1). Re-analysis with FIGO 2018 system resulted in higher stage in all subgroups except IAI, IA2, IVA, and IVB disease. Upstaging occurred in the majority of patients: 8 (73%) of the stage IB1 patients, (37% to IB2, 9% to IB3, and 27% to IIIC1), 18 (100%) of stage IB2 patients, (67% to IB3, 28% to IIIC1, and 5% to IIIC2), 3 (27%) of stage IIA1 patients, (9% to IIIC1 and 18% to IVB), 5 (50%) of stage IIA2 patients, (40% to IIIC1 and 10% to IIIC2), 19 (54%) of stage IIB patients (20% to IIIC1, 23% to IIIC2, and 11% to IVB), 3 (75%) of the stage IIIA patients (75% to IIIC1), 28 (72%) of the stage IIIB patients, (38% to IIIC1, 18% to IIIC2, 3% to IVA, and 13% to IVB). Survival analysis was performed to compare FIGO 2009 and 2018 staging without any statistical significance seen between the two groups for stage I (p=0.79), stage IIA (p=0.88), stage IIB (p=0.42), stage IIIA/IIIB (p=0.86), and stage IV (p=0.16). A trend toward significance when comparing survival for the FIGO 2009 IIIA/IIIB and FIGO 2018 IIIC2 stage was noted with stage IIIC2 patients having a worse median survival (33 months) compared to stage IIIB/IIIA patients (66 months), p=0.059. Migration to higher stage subgroups occurred in the majority of patients with use of the FIGO 2018 staging system. Survival outcomes for stages I, II, IIIA, IIIB, and IV correlate with the previous 2009 system. Para-aortic node involvement on imaging (FIGO stage IIIC2) correlated with worse survival that trended towards significance when compared to stage FIGO IIIA/IIIB disease, validating the utility of separating these two groups.Abstract 2766; Table 1Staging shifts based on FIGO 2009 vs. FIGO 2018 stagingFIGO 2009Total Number of Patients (141)FIGO 2018Stage 1A1, 1A22 (1%), 2 (1%)Same stageStage 1B1, 1B2, 1B311 (8%), 18 (13%), NAUpstaged 8 (73%), 18 (100%), NAStage IIA1, IIA211 (8%), 10 (7%)Upstaged 3 (27%), 5 (50%)Stage IIB35 (25%)Upstaged 19/35 (54%) 7/35 (20%) - Stage IIIC1 8/35 (23%) - Stage IIIC2 4/35 (11%) - Stage IVBStage IIIA4 (3%)Upstaged 3/4 (75%) 3/4 (75%)- Stage IIIC1Stage IIIB39(27%)Upstaged 28/39 (72%) 15/39 (38%) -Stage IIIC1 7/39 (18%) - Stage IIIC2 1/39 (3%) - Stage IVA 5/39 (13%)- Stage IVBStage IIIC1 and IIIC2NAStage IVA and IVB5/141 (4%) and 4/141 (3%)Same stageOverall141Same stage 57/141 (40%) Upstaged 84/141 (60%) Open table in a new tab