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Redistribution of Cervix Cancer Patients from FIGO 2009 to FIGO 2018 Staging Following Incorporation of Medical Imaging

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Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Objectives

The aim of this study was to quantify the shift in patients from the FIGO 2009 to the FIGO 2018 staging using a prospectively collected dataset where pre-treatment MRI and PET-CT were used. A secondary aim was to explore the distribution of known prognostic factors in both staging schema.

Methods

Prospectively collected dataset of 1047 cervix cancer patients staged with MRI and PET-CT, between 1996 and 2014, were redistributed using FIGO 2018 staging criteria. Standard deviation inter-quartile and contingency tables were used to present the distribution of patients according to FIGO 2009 and FIGO 2018 criteria. Logistic regression was used to evaluate the association of node positivity and nodal size.

Results and Discussion

In total, 853 patients were available for analyses. Based on MRI and PET findings, according to FIGO 2009, the incidence of lymph node metastasis was similar in (1) stages 1b1 and 2a1, (2) 1b, 2a2, 2b and 3a (3) 3b and 4a. Nodal metastases were found in 43% patients who were upstaged from FIGO 2009 to newly created FIGO 2018 stages 3c1 and 3c2. Contribution to stage 3c1 came from 31, 41, 29, 30, 32, 33 and 34% of stages 1b1, 1b2, 2a1, 2a2, 3a and 3b, respectively. FIGO 2009 stages 1b1 and 1b2 contributed 5 and 6%, stages 2a1, 2a2, 2b and 3a contributed 16, 15 and 15% to para-aortic nodes, while stage 3b contributed 24%. These findings will likely influence cervix cancer treatment policies.

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References

  1. Landoni F, Maneo A, Colombo A, Placa F, Milani R, Perego P, et al. Randomised study of radical surgery versus radiotherapy for stage Ib–IIa cervical cancer [see comments]. Lancet. 1997;350(9077):535–40.

    Article  CAS  Google Scholar 

  2. Grover S, Xu MJ, Yeager A, Rosman L, Groen RS, Chackungal S, et al. A systematic review of radiotherapy capacity in low- and middle-income countries. Front Oncol. 2014;4:380.

    PubMed  Google Scholar 

  3. Narayan K, McKenzie A, Fisher R, Susil B, Jobling T, Bernshaw D. Estimation of tumor volume in cervical cancer by magnetic resonance imaging. Am J Clin Oncol. 2003;26(5):e163–8.

    Article  Google Scholar 

  4. Narayan K, Fisher R, Bernshaw D. Significance of tumor volume and corpus uteri invasion in cervical cancer patients treated by radiotherapy. Int J Gynecol Cancer. 2006;16(2):623–30.

    Article  CAS  Google Scholar 

  5. Delgado G, Bundy B, Zaino R, Sevin BU, Creasman WT, Major F. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol. 1990;38(3):352–7.

    Article  CAS  Google Scholar 

  6. Benedet JL, Bender H, Jones H III, Ngan HY, Pecorelli S. FIGO staging classifications and clinical practice guidelines in the management of gynecologic cancers. FIGO Committee on Gynecologic Oncology. Int J Gynaecol Obstet. 2000;70(2):209–62.

    Article  CAS  Google Scholar 

  7. Lagasse LD, Creasman W, Shingleton HM, Ford JH, Blessing J. Results and complications of operative staging in cervical cancer: experience of the Gynecologic Oncology Group. Gynecol Oncol. 1980;9(1):90–8.

    Article  CAS  Google Scholar 

  8. Bhatla N, Aoki D, Sharma DN, Sankaranarayanan R. Cancer of the cervix uteri. Int J Gynaecol Obstet. 2018;143(Suppl 2):22–36.

    Article  Google Scholar 

  9. Noel P, Dube M, Plante M, St-Laurent G. Early cervical carcinoma and fertility-sparing treatment options: MR imaging as a tool in patient selection and a follow-up modality. Radiographics. 2014;34(4):1099–119.

    Article  Google Scholar 

  10. Qu JR, Qin L, Li X, Luo JP, Li J, Zhang HK, et al. Predicting parametrial invasion in cervical carcinoma (Stages IB1, IB2, and IIA): diagnostic accuracy of T2-weighted imaging combined with DWI at 3 T. AJR Am J Roentgenol. 2018;210(3):677–84.

    Article  Google Scholar 

  11. Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF. Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS ONE. 2018;13(10):e0204950.

    Article  Google Scholar 

  12. Alcazar JL, Arribas S, Minguez JA, Jurado M. The role of ultrasound in the assessment of uterine cervical cancer. J Obstet Gynaecol India. 2014;64(5):311–6.

    Article  Google Scholar 

  13. Plante M. Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer. 2013;23(6):982–9.

    Article  Google Scholar 

  14. Cibula D, Abu-Rustum NR, Fischerova D, Pather S, Lavigne K, Slama J, et al. Surgical treatment of “intermediate risk” lymph node negative cervical cancer patients without adjuvant radiotherapy—a retrospective cohort study and review of the literature. Gynecol Oncol. 2018;151(3):438–43.

    Article  Google Scholar 

  15. Matsumura M, Takeshima N, Ota T, Omatsu K, Sakamoto K, Kawamata Y, et al. Neoadjuvant chemotherapy followed by radical hysterectomy plus postoperative chemotherapy but no radiotherapy for Stage IB2-IIB cervical cancer–irinotecan and platinum chemotherapy. Gynecol Oncol. 2010;119(2):212–6.

    Article  Google Scholar 

  16. Narayan K, Fisher RJ, Bernshaw D, Shakher R, Hicks RJ. Patterns of failure and prognostic factor analyses in locally advanced cervical cancer patients staged by positron emission tomography and treated with curative intent. Int J Gynecol Cancer. 2009;19(5):912–8.

    Article  Google Scholar 

  17. Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. J Clin Oncol. 2001;19(17):3745–9.

    Article  CAS  Google Scholar 

  18. Rajasooriyar C, Van Dyk S, Bernshaw D, Kondalsamy-Chennakesavan S, Barkati M, Narayan K. Patterns of failure and treatment-related toxicity in advanced cervical cancer patients treated using extended field radiotherapy with curative intent. Int J Radiat Oncol Biol Phys. 2011;80(2):422–8.

    Article  Google Scholar 

  19. Narayan K. Arguments for a magnetic resonance imaging–assisted FIGO staging system for cervical cancer. Int J Gynecol Cancer. 2005;15(4):573–82.

    CAS  PubMed  Google Scholar 

  20. Kodaira T, Fuwa N, Toita T, Nomoto Y, Kuzuya K, Tachibana H, et al. Comparison of prognostic value of MRI and FIGO stage among patients with cervical carcinoma treated with radiotherapy. Int J RadiatOncol BiolPhys. 2003;56(3):769–77.

    Article  Google Scholar 

  21. Narayan K. Response to the letter of Soutter and deSouza. Int J Gynecol Cancer. 2006;16(3):1488–98.

    Google Scholar 

  22. Matoda M, Takeshima N, Michimae H, Iwata T, Yokota H, Torii Y, et al. Postoperative chemotherapy for node-positive cervical cancer: results of a multicenter phase II trial (JGOG1067). Gynecol Oncol. 2018;149(3):513–9.

    Article  CAS  Google Scholar 

  23. Narayan K, Lin MY. Staging for cervix cancer: role of radiology, surgery and clinical assessment. Best Pract Res Clin Obstet Gynaecol. 2015;29(6):833–44.

    Article  Google Scholar 

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Funding

No financial remuneration was recieved by any authors towards writing this manuscript or data collection.

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Authors and Affiliations

  1. Radiation Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, Melbourne, VIC, 8006, Australia

    Kailash Narayan, Ming Yin Lin & David Bernshaw

  2. Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia

    Kailash Narayan

  3. Rural Clinical School, The University of Queensland, Toowoomba, Australia

    Srinivas Kondalsamy-Chennakesvan

  4. Department of Gynecologic Oncology, Tata Memorial Centre, Mumbai, India

    Amita Maheshwari

  5. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India

    Neerja Bhatla

Authors
  1. Kailash Narayan
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  2. Ming Yin Lin
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  3. Srinivas Kondalsamy-Chennakesvan
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  4. David Bernshaw
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  5. Amita Maheshwari
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  6. Neerja Bhatla
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Correspondence to Kailash Narayan.

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Narayan, K., Lin, M.Y., Kondalsamy-Chennakesvan, S. et al. Redistribution of Cervix Cancer Patients from FIGO 2009 to FIGO 2018 Staging Following Incorporation of Medical Imaging. Indian J Gynecol Oncolog 17, 93 (2019). https://doi.org/10.1007/s40944-019-0347-5

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  • DOI: https://doi.org/10.1007/s40944-019-0347-5

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