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

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).

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.