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  • 2022-RA-799-ESGO Impact of imaging- and pathology findings for stage migration and prognostication using the FIGO (2018) staging system in cervical cancer

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Cervical cancer
2022-RA-799-ESGO Impact of imaging- and pathology findings for stage migration and prognostication using the FIGO (2018) staging system in cervical cancer
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  1. Kari Strøno Wagner-Larsen1,2,
  2. Njål Lura1,2,
  3. Mari Kyllesø Halle3,4,
  4. Øyvind Salvesen5,
  5. Bjørn Inge Bertelsen6,
  6. Kathrine Woie3,
  7. Camilla Krakstad3,4 and
  8. Ingfrid Haldorsen1,2
  1. 1Department of Radiology, Haukeland University Hospital, Bergen, Norway
  2. 2Section for Radiology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
  3. 3Department of Obstretrics and Gynecology, Haukeland University Hospital, Bergen, Norway
  4. 4Centre for Cancer Biomarkers CCBIO, Department of Clinical Science, University of Bergen, Bergen, Norway
  5. 5Clinical Research Unit, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
  6. 6Department of Pathology, Haukeland University Hospital, Bergen, Norway

Abstract

Introduction/Background The updated FIGO (2018) staging system incorporates diagnostic imaging and pathology results into stage assignment in cervical cancer (CC). This study aims to evaluate the extent and source of stage migration when exchanging FIGO (2009) with FIGO (2018) in a large CC cohort and compare the prognostic performance of FIGO (2009)- and FIGO (2018) stage.

Methodology In total, 473 CC patients diagnosed during 2002–2020 with available pretreatment imaging were included. Clinicopathological information and results from magnetic resonance imaging (MRI) (473/473), fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) (180/473), and chest/abdominal CT (394/473) were recorded (collected from patient records). All patients were staged according to FIGO (2009)- and retrospectively according to the FIGO (2018) criteria. Time-dependent receiver operating characteristic (tdROC) curves for predicting disease-specific survival (DSS) at 5 years were generated for FIGO (2009) versus FIGO (2018).

Abstract 2022-RA-799-ESGO Figure 1
Abstract 2022-RA-799-ESGO Figure 1

A) Table displaying the stage migration from FIGO (2009) to FIGO (2018); B) Alluvial plot illustrating the migration from FIGO (2009) to FIGO (2018) (stages I–IV), and the disease-specific survival (DSS) for the same patients (median [interquartile range] follow-up time 77 [45–113] months). The color of the alluvial splinos are blue if the FIGO (2018) reclassification was based on pathology and red if the reclassification was based on imaging; C) Time-dependent receiver operating characteristics (IdROC) curves for prediction of 5-year DSS based on FIGO (2009) and FIGO (2018)

Results When reassigning FIGO stage, 47% (224/473) of the CC patients had a different FIGO (2018) stage than the FIGO (2009) stage; 34% (163/473) were upstaged, whereas 13% (61/473) were downstaged using FIGO (2018). For FIGO (2018), stage I (n=272) was defined by pathology findings in 81% (220/272), whereas stages II (n=64), III (n=104), and IV (n=33) were mostly defined by imaging findings (85%; 170/201). For FIGO (2018) stage III, stage migration was seen in 95% (99/104), mainly due to positive lymph nodes on imaging (in 89%; 93/104). FIGO (2018) yielded higher area under the tdROC curve (AUC) for predicting 5-year DSS than FIGO (2009) (AUC 0.89 vs. AUC 0.83, respectively; p = 0.009).

Conclusion Restaging to FIGO (2018) resulted in stage migration in 47% of the patients. FIGO (2018) stage I was mostly defined by pathology results, while imaging findings had a strong impact on stages II-IV. FIGO (2018) stage yielded higher AUC than FIGO (2009) for predicting 5-year DSS in CC.

https://doi.org/10.1136/ijgc-2022-ESGO.60

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