Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Population Characteristics
2.2. FIGO Stage Modification
2.3. Survical Outcomes
3. Discussion
4. Materials and Methods
4.1. Patient Selection
4.2. Data Analysis
4.3. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Total Population N = 246 | |
---|---|---|
N Patients or Median | % or (Range) | |
Age at diagnosis [years] | ||
All patients | 42 | (22–85) |
<50 | 181 | 73.6 |
50–70 | 56 | 22.8 |
>70 | 9 | 3.7 |
Body Mass-Index [kg/m2] | ||
All patients | 22.7 | (14.6–41.4) |
<18.5 | 20 | 8.1 |
18.5–25 | 154 | 62.6 |
<25–30 | 43 | 17.5 |
>30 | 29 | 11.8 |
Menopausal status | ||
Premenopausal | 174 | 70.7 |
Postmenopausal | 72 | 29.3 |
Histology | ||
Squamous cell carcinoma | 166 | 67.5 |
Adenocarcinoma | 74 | 30.1 |
Other type | 6 | 2.4 |
Grade of differenciation | ||
G1 | 77 | 43.0 |
G2 | 65 | 36.3 |
G3 | 37 | 20.7 |
Not specified | 65 | - |
Conisation | ||
Yes | 150 | 61.0 |
No | 96 | 39.0 |
Preoperative brachytherapy | ||
Yes | 66 | 26.8 |
No | 180 | 73.2 |
Surgical procedure | ||
Type of surgery | ||
Radical Hysterectomy | 199 | 80.9 |
Radical Trachelectomy | 47 | 19.1 |
Type of surgical approach | ||
Minimal Invasive Surgery | 229 | 93.1 |
Laparotomy | 17 | 6.9 |
Type of Lymph node staging | ||
SLN alone | 77 | 31.3 |
SLN + Pelvic lymphadenectomy | 169 | 68.7 |
Final pathologic examination | ||
Tumor size | ||
<20 mm | 200 | 81.3 |
≥20 mm | 46 | 18.7 |
Deep stromal invasion | ||
<10 mm | 178 | 80.2 |
≥10 mm | 44 | 19.8 |
Not specified | 24 | - |
LVSI | ||
Yes | 57 | 23.2 |
No | 189 | 76.8 |
Positive margin | ||
Yes | 9 | 3.7 |
No | 237 | 96.3 |
Patients with ≥1 positive node | ||
Yes | 15 | 6.1 |
No | 231 | 93.9 |
Adjuvant treatment | ||
None | 186 | 75.6 |
Brachytherapy | 29 | 11.8 |
EBRT | 11 | 4.5 |
CCR | 20 | 8.1 |
Outcomes | ||
Recurrence | ||
None | 226 | 91.5 |
Nodal | 5 | 2.0 |
Vaginal | 5 | 2.0 |
Pelvic | 5 | 2.0 |
Distant metastases | 6 | 2.4 |
Status | ||
Alive | 238 | 96.8 |
Dead | 8 | 3.2 |
Predictive Variable | IB1 LVSI− N = 150 | IB1 LVSI+ N = 36 | p | ||
---|---|---|---|---|---|
N Patients or Mean ± SD | % or (Range) | N Patients or Mean ± SD | % or (Range) | ||
Age (years) | |||||
All patients | 43.8 ± 12.3 | (22–85) | 43.1 ± 12.3 | (26–72) | 0.74 |
<50 | 112 | 74.7 | 25 | 69.4 | 0.68 |
50–70 | 32 | 21.3 | 10 | 27.8 | |
> 70 | 6 | 4.0 | 1 | 2.8 | |
BMI [kg/m2] | |||||
All patients | 23.9 ± 5.2 | (14.6–41.4) | 23.5 ± 4.8 | (17.4–37.7) | 0.72 |
<18.5 | 10 | 6.7 | 1 | 2.8 | 0.75 |
18.5–25 | 97 | 64.7 | 26 | 72.2 | |
<25–30 | 26 | 17.3 | 5 | 13.9 | |
>30 | 17 | 11.3 | 4 | 11.1 | |
Menopausal status | |||||
Premenopausal | 107 | 71.3 | 25 | 69.4 | 0.83 |
Postmenopausal | 43 | 28.7 | 11 | 30.6 | |
Histology | |||||
Squamous cell carcinoma | 101 | 67.3 | 25 | 69.4 | 0.43 |
Adenocarcinoma | 46 | 30.7 | 9 | 25.0 | |
Other type | 3 | 2.0 | 2 | 5.6 | |
Grade of differenciation | |||||
G1 | 47 | 45.2 | 10 | 35.7 | 0.22 |
G2 | 39 | 37.5 | 9 | 32.1 | |
G3 | 18 | 17.3 | 9 | 32.1 | |
Not specified | 46 | - | 8 | - | |
Conisation | |||||
Yes | 100 | 67.1 | 22 | 61.1 | 0.49 |
No | 49 | 32.9 | 14 | 38.9 | |
Preoperative brachytherapy | |||||
Yes | 47 | 31.3 | 7 | 19.4 | 0.16 |
No | 103 | 68.7 | 29 | 80.6 | |
Surgical procedure | |||||
Type of surgery | |||||
Radical Hysterectomy | 118 | 78.7 | 30 | 83.3 | 0.53 |
Radical Trachelectomy | 32 | 21.3 | 6 | 16.7 | |
Type of surgical approach | |||||
Minimal Invasive Surgery | 143 | 95.3 | 35 | 97.2 | 0.62 |
Laparotomy | 7 | 4.7 | 1 | 2.8 | |
Type of Lymph node staging | |||||
SLN alone | 58 | 38.7 | 9 | 25.0 | 0.12 |
SLN + Pelvic lymphadenectomy | 92 | 61.3 | 27 | 75.0 | |
Final pathologic exam | |||||
Tumor size (mm) | 2.9 ± 5.2 | (0–18) | 7.5 ± 7.4 | (0–18) | <0.0001 |
Deep stromal invasion | |||||
Mean | 2.1 ± 4.9 | (0–20) | 5.4 ± 6.1 | (0–20) | 0.001 |
<10 mm | 132 | 94.3 | 23 | 67.6 | <0.0001 |
≥10 mm | 8 | 5.7 | 11 | 32.4 | |
Not specified | 10 | - | 2 | - | |
Positive margin | |||||
Yes | 5 | 3.3 | 2 | 5.6 | 0.53 |
No | 145 | 96.7 | 34 | 94.4 | |
Presence of ITCs | |||||
Yes | 3 | 2.0 | 1 | 2.8 | 0.77 |
No | 147 | 98.0 | 35 | 97.2 | |
Adjuvant treatment | |||||
None | 136 | 90.7 | 24 | 66.7 | 0.0002 |
Brachytherapy | 10 | 6.7 | 9 | 25.0 | |
EBRT | 1 | 0.7 | 3 | 8.3 | |
CCR | 3 | 2.0 | 0 | 0.0 |
2009 FIGO Classification | 2018 FIGO Classification | 2018 FIGO Classification with LVSI Status | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2009 FIGO | n | Number of events | 5-year DFS | 2018 FIGO | n | Number of events | 5-year DFS | HR | 95% CI | p | 2018 FIGO | n | Number of events | 5-year DFS | HR | 95% CI | p |
IB1 | 246 | 20 | 90.0% | IB1 | 186 | 11 | 92.9% | 1 | IB1 LVSI− | 150 | 6 | 95.8% | 1 | ||||
IB1 LVSI+ | 36 | 5 | 82.5% | 3.33 | 1.02–10.91 | 0.047 | |||||||||||
IB2 | 45 | 8 | 78.6% | 3.31 | 1.33–8.23 | 0.003 | IB2 | 45 | 8 | 78.6% | 4.85 | 1.68–13.98 | 0.003 | ||||
IIIC | 15 | 1 | 91.7% | 1.09 | 0.14–8.44 | 0.93 | IIIC | 15 | 1 | 91.7% | 1.60 | 0.19–13.27 | 0.66 |
2009 FIGO Classification | 2018 FIGO Classification | 2018 FIGO Classification with LVSI Status | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
2009 FIGO | n | Number of events | 5-year DFS | 2018 FIGO | n | Number of events | 5-year DFS | HR | 95% CI | p | 2018 FIGO | n | Number of events | 5-year DFS | HR | 95% CI | p |
IB1 | 246 | 8 | 96.2% | IB1 | 186 | 4 | 97.3% | 1 | IB1 LVSI− | 150 | 2 | 98.2% | 1 | ||||
IB1 LVSI+ | 36 | 2 | 94.2% | 3.99 | 0.56–28.34 | 0.17 | |||||||||||
IB2 | 45 | 4 | 90% | 4.35 | 1.09–17.4 | 0.04 | IB2 | 45 | 4 | 90.0% | 6.96 | 1.27–38.01 | 0.03 | ||||
IIIC | 15 | 0 | 100% | NA | NA | NA | IIIC | 15 | 0 | 100% | NA | NA | NA |
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Balaya, V.; Guani, B.; Magaud, L.; Bonsang-Kitzis, H.; Ngô, C.; Mathevet, P.; Lécuru, F.; on behalf of the SENTICOL Group. Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage. Cancers 2020, 12, 3554. https://doi.org/10.3390/cancers12123554
Balaya V, Guani B, Magaud L, Bonsang-Kitzis H, Ngô C, Mathevet P, Lécuru F, on behalf of the SENTICOL Group. Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage. Cancers. 2020; 12(12):3554. https://doi.org/10.3390/cancers12123554
Chicago/Turabian StyleBalaya, Vincent, Benedetta Guani, Laurent Magaud, Hélène Bonsang-Kitzis, Charlotte Ngô, Patrice Mathevet, Fabrice Lécuru, and on behalf of the SENTICOL Group. 2020. "Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage" Cancers 12, no. 12: 3554. https://doi.org/10.3390/cancers12123554
APA StyleBalaya, V., Guani, B., Magaud, L., Bonsang-Kitzis, H., Ngô, C., Mathevet, P., Lécuru, F., & on behalf of the SENTICOL Group. (2020). Validation of the 2018 FIGO Classification for Cervical Cancer: Lymphovascular Space Invasion Should Be Considered in IB1 Stage. Cancers, 12(12), 3554. https://doi.org/10.3390/cancers12123554