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EPV048/#252 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,
  2. O Mogensen3,4,
  3. M Hildebrandt2,5,6,
  4. D Schledermann2,7,
  5. E Parner8,
  6. A Markauskas1,
  7. L Frøding9,
  8. K Fuglsang3,
  9. J Holm5,
  10. S Bjørnholt3,4 and
  11. P Jensen2,3,4
  1. 1Odense University Hospital, Department of Gynecology and Obstetrics, Odense C, Denmark
  2. 2University of Southern Denmark, Department of Clinical Research, Odense C, Denmark
  3. 3Aarhus University Hospital, Department of Gynecology and Obstetrics, Aarhus N, Denmark
  4. 4Aarhus University, Institute of Clinical Medicine, Aarhus, Denmark
  5. 5Odense University Hospital, Department of Nuclear Medicine, Odense C, Denmark
  6. 6Odense University Hospital and University of Southern Denmark, Center For Innovative Medical Technology, Odense C, Denmark
  7. 7Odense University Hospital, Department of Pathology, Odense C, Denmark
  8. 8Aarhus University, Department of Public Health, Aarhus, Denmark
  9. 9Copenhagen University Hospital, Department of Gynecology, Copenhagen, Denmark


Objectives 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.

Methods 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 tumor characteristics associated with nodal metastases.

Results Stage migration occurred in 80.4% (197/245), due to tumor 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 tumor characteristics were upstaged to IIIC1 due to the findings of nodal metastases. The depth of invasion ranged from 4–5 mm and the tumor 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.

Conclusions 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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