FIGO 2018 staging criteria for cervical cancer: Impact on stage migration and survival.

To compare FIGO 2009 and FIGO 2018 cervical cancer staging criteria with a focus on stage migration and treatment outcomes. This study is based on a database cohort of 1282 patients newly diagnosed with cervical cancer from 1997 to 2019. All underwent standard clinical examination and whole-body FDG-PET. Tumor stage was recorded using the FIGO 2009 system, which excluded surgical pathologic, FDG-PET and other advanced imaging findings, and then re-classified to the FIGO 2018 system, including surgical pathologic and imaging findings. Patient management was based on clinical, surgical, and imaging findings. Stage migration and prognosis were evaluated. The distribution per the 2009 staging system was stage I in 593 (46%), stage II in 342 (27%), stage III in 263 (21%), and stage IV in 84 (7%) and the 2018 staging system was stage I in 354 (28%), stage II in 156 (12%), stage III in 601 (47%), and stage IV in 171 (13%). No patients were down-staged. Stage migration occurred in 53% (676/1282) and was attributable to detection of occult lymph node metastasis in 520 (41%), occult distant metastasis in 90 (7%), and tumor size and extent in 66 (5%). The 5-year progression-free survivals (PFS) by FIGO 2009 versus FIGO 2018 were as follows: stage I, 80% vs. 87% (p = 0.02); stage II, 59% vs. 71% (p = 0.002); stage III, 35% vs. 55% (p < 0.001), and stage IV, 20% vs. 16% (p = 0.41). Inclusion of surgical pathologic and imaging findings resulted in upward stage migration in the majority, mostly related to nodal and distant metastasis. While FIGO 2018 improves survival discriminatory ability for stages I and IV patients, survival remains heterogeneous among stage III substages.

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Déclaration de conflit d'intérêts

Declaration of competing interest Perry Grigsby: None. Leslie Massad: None. David Mutch: Writing-Review and Editing. Matthew Powell: Reports personal fees from Tesaro, personal fees from Merck, personal fees from Roche/Genentech, personal fees from Clovis Oncology, personal fees from AstraZeneca, personal fees from Johnson & Johnson, personal fees from Eisai, outside the submitted work. Premal Thaker: Reports grants and personal fees from Merck, grants and personal fees from Tesaro, personal fees from Astra Zeneca, personal fees from Celsion, personal fees from Abbvie, personal fees from Iovance, personal fees from Stryker, personal fees from Clovis, personal fees from Genetech, outside the submitted work. Carolyn McCourt: None. Andrea Hagemann: None. Katherine Fuh: None. Lindsay Kuroki: Reports grants from Washington University Institute of Clinical and Translational Sciences (KL2), from null, during the conduct of the study. Julie Schwarz: None. Stephanie Markovina: None. Alexander Lin: None. Farrokh Dehdashti: None. Barry Siegel: None.