New FIGO staging (2018) of cervix cancer and its impact on treatment

Objectives: The aim of this study was to quantify the shift in patients from the 2009 to the 2018 FIGO 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 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: 853 patients were available for distribution analyses and 754 patient were available for survival analysis. Based on MRI and PET findings, according to FIGO 2009, the incidence of lymph node metastasis were similar in 1) Stage 1b1 and 2a1, 2) 1b2, 2a2 and 2b and 3) 3b and 4a. Nodal metastases were found in 43% patients who were up-staged from FIGO 2009 to newly created FIGO 2018 stage 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 stage 1b1and1b2 contributed to 5 and 6%, stage 2a1, 2a2, 2b and 3a contributed to 16, 15 and 15% to para-aortic nodes while stage 3b contributing to 24%. These findings will likely influence cervix cancer treatment policies.

Kailash Narayan

Peter MacCallum Cancer Centre
Consultant Radiation Oncologist