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Prognostic Performance of the 2018 International Federation of Gynecology and Obstetrics Cervical Cancer Staging Guidelines

Wright, Jason D. MD; Matsuo, Koji MD, PhD; Huang, Yongmei MD, MPH; Tergas, Ana I. MD, MPH; Hou, June Y. MD; Khoury-Collado, Fady MD; St. Clair, Caryn M. MD; Ananth, Cande V. PhD, MPH; Neugut, Alfred I. MD, PhD; Hershman, Dawn L. MD

doi: 10.1097/AOG.0000000000003311
Contents: Gynecologic Oncology: Original Research
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OBJECTIVE: To examine the prognostic performance of the revised 2018 International Federation of Gynecology and Obstetrics (FIGO) cervical cancer staging schema.

METHODS: We used the National Cancer Database to identify women with cervical cancer diagnosed from 2004 to 2015. Using clinical and pathologic data, each patient's stage was classified using three staging schemas: American Joint Committee on Cancer 7th edition, FIGO 2009 and FIGO 2018. The FIGO 2018 revised staging classifies stage IB tumors into three substages based on tumor size (IB1–IB3) and classifies patients with positive lymph nodes (pathologically or clinically detected) as stage IIIC1 (positive pelvic nodes) or IIIC2 (positive para-aortic nodes). Five-year survival rates were estimated for each stage grouping. We sought to determine whether the 2018 FIGO staging system was able to offer improved 5-year survival rate differentiation compared with older staging schemas.

RESULTS: A total of 62,212 women were identified. The classification of stage IB tumors into three substages improved discriminatory ability. Five-year survival in the FIGO 2018 schema was 91.6% (95% CI 90.4–92.6%) for stage IB1 tumors, 83.3% (95% CI 81.8–84.8%) for stage IB2 neoplasms, and 76.1% (95% CI 74.3–77.8%) for IB3 lesions. In contrast, for women with stage III tumors, higher FIGO staging was not consistently associated with worse 5-year survival rates: stage IIIA (40.7%, 95 CI 37.1–44.3%), stage IIIB (41.4%; 95% CI 39.9–42.9%), stage IIIC1 (positive pelvic nodes) was 60.8% (95% CI 58.7–62.8%) and stage IIIC2 37.5% (95% CI 33.3–41.7%).

CONCLUSION: The FIGO 2018 staging schema provides improved discriminatory ability for women with stage IB tumors; however, classification of all women with positive lymph nodes into a single stage results in a very heterogeneous group of patients with highly variable survival rates.

The revised staging schema improves discriminatory ability for stage IB tumors; however, classification of all positive nodes into a single stage results in a heterogeneous group.

Columbia University College of Physicians and Surgeons, the Joseph L. Mailman School of Public Health, Columbia University, and the Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, New York, New York; the University of Southern California, Los Angeles, California; and Rutgers Robert Wood Johnson Medical School, and the Environmental and Occupational Health Sciences Institute (EOHSI), Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey.

Corresponding author: Jason D. Wright, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; email: jw2459@columbia.edu.

Financial Disclosure Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. Dr. Matsuo has received an honorarium from Chugai and money paid to him from Springer for a textbook editorial. He has also received meeting expenses paid from OVAL. Dr. Neugut has served as a consultant to Pfizer, Teva, Otsuka, Hospira, and United Biosource Corporation. He is on the scientific advisory board of EHE, Intl. The other authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews are available at http://links.lww.com/AOG/B419.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.