Abstract
ObjectivesWe aimed to evaluate if the revised staging according to FIGO-2018 in early-stage cervical cancer correctly predicts the risk for nodal metastases. MethodsWe 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. ResultsStage 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). ConclusionsThe 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.
Highlights
The International Federation of Gynecology and Obstetrics (FIGO) revised the cervical cancer staging in 2018 [1,2]
Women with and without nodal metastases did not differ in age, Body Mass Index (BMI), or Charlson Comorbidity Index (CCI)
We evaluated the risk of lymph node metastases according to the revised FIGO-2018 staging and tumor characteristics in a large sample of 245 women with early-stage cervical cancer
Summary
The International Federation of Gynecology and Obstetrics (FIGO) revised the cervical cancer staging in 2018 [1,2]. Several matters of controversy have been raised With this paradigm shift to only involving depth of invasion as the cut-off for IA stages, a proportion of women with comparatively large microscopic horizontal width are downstaged. The recommendations include a cone biopsy, cervical amputation, or simple hysterectomy in women with tumor size ≤20 mm, type A-B radical hysterectomy or trachelectomy in tumors >7–20 mm with LVSI, and SLN mapping in all women with tumors >7–20 mm [5] This is a cautious adaptation to FIGO-2018 while awaiting international results from studies applying conservative surgical management in women with low risk of metastases such as no lymphovascular space invasion (LVSI), depth of invasion ≤10 mm and tumor size ≤20 mm (SHAPE, GOG-278, and ConCerv) [6,7,8]
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