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601 Transition from FIGO-2009 to FIGO-2018 in women with early-stage cervical cancer; does the revised staging correctly reflect risk groups?
  1. S Sponholtz1;2;3,
  2. O Mogensen4;5,
  3. M Hildebrandt1;6;7,
  4. D Schledermann1;8,
  5. E Parner9,
  6. A Markauskas2,
  7. L Froeding10,
  8. K Fuglsang4,
  9. J Holm6,
  10. S Bjørnholt4;5 and
  11. P Jensen1;4;5
  1. 1University of Southern Denmark, Institute of Clinical Research, Odense C, Denmark
  2. 2Odense University Hospital, Department of Gynaecology and Obstetrics, Odense C, Denmark
  3. 3Odense University Hospital and Region of Southern Denmark, Open Patient Data Explorative Network, Odense C, Denmark
  4. 4Aarhus University Hospital, Department of Gynaecology and Obstetrics, Aarhus N, Denmark
  5. 5Aarhus University , Institute of Clinical Medicine, Aarhus N, Denmark
  6. 6Odense University Hospital, Department of Nuclear Medicine, Odense C, Denmark
  7. 7Odense University Hospital and University of Southern Denmark, Centre for Innovative Medical Technology, Odense C, Denmark
  8. 8Odense University Hospital, Department of Pathology, Odense C, Denmark
  9. 9Aarhus University, Department of Public Health, Aarhus C, Denmark
  10. 10Copenhagen University Hospital, Department of Gynaecology, Kbh Ø, Denmark


Introduction/Background*The International Federation of Gynaecology and Obstetrics (FIGO) revised cervical cancer staging in 2018. We aimed to evaluate risk factors associated with lymph node macro- and micrometastases in women with early-stage cervical cancer, focusing on the revised FIGO-2018 staging system. The overall purpose was to evaluate if the stage migration related to the implementation of FIGO-2018 correctly reflects risk groups as indicated by the presence of lymph node metastases.

Methodology Using data from a national prospective cohort study on sentinel lymph node (SLN) mapping in 245 women with early-stage cervical cancer, we reallocated women from FIGO-2009 to FIGO-2018 stages. We used binary and multiple regression models to investigate the risk ratio of FIGO-2018 stages and tumour characteristics associated with nodal metastases.

Result(s)*Stage migration occurred in 80.4% (197/245), due to tumour size or depth of invasion in 75.1% (148/197), nodal metastases in 19.3% (38/197), and imaging in 4.5% (11/245). Downstaging to FIGO-2018 IA stages occurred in 36,7% (90/245). Six (5.7%) women with stage IA tumour characteristics were upstaged to IIIC1 due to the findings of nodal metastases. The depth of invasion ranged from 4-5 mm and the tumour size from 9-22 mm; all six metastases were SLNs. For the whole population, risk factors significantly associated with nodal metastases were FIGO-2018 IB2 (p < 0.001), parametrial invasion (p < 0.001), and lymphovascular space invasion (LVSI) (p < 0.001). All three remained significantly associated with nodal metastases in a multivariate analysis.

Conclusion*The FIGO-2018 revised staging system causes stage migration for a large proportion of women with early-stage cervical cancer. The attention on depth of invasion rather than horizontal dimension seems to reflect the risk of nodal metastases correctly. The use of sentinel node mapping in stage IA FIGO-2018 appears to be justified.

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