Prognostic value of the 2018 FIGO staging system for cervical cancer patients with surgical risk factors

Figures & data

Table 1 Patient and tumor characteristics (n = 662)

Characteristics
Median age, years, (range)	45 (21–74)
Pathologic type, n (%)
Squamous cell	555 (83.9%)
Adenocarcinoma	77 (11.6%)
Adenosquamous	30 (4.5%)
Tumor size, n (%)
≤4.0 cm	472 (71.3%)
>4 cm	190 (28.7%)
DSI, n (%)
≤1/2	309 (46.7%)
>1/2	353 (53.3%)
LVSI, n (%)
Negative	374 (56.5%)
Positive	288 (43.5%)
SM status, n (%)
Negative	646 (97.6%)
Positive	16 (2.4%)
PI, n (%)
Negative	646 (97.6%)
Positive	16 (2.4%)
Nodal metastasis, n (%)
Negative	475 (71.8%)
Positive	187 (28.2%)
Adjuvant therapy, n (%)
RT	181 (27.3%)
CCRT	283 (42.7%)
No	198(30.0%)
FIGO 2009 stage, n (%)
IB1	336 (50.8%)
IB2	99 (15.0%)
IIA1	130 (19.6%)
IIA2	97 (14.6%)
FIGO 2018 stage, n (%)
IB1	149 (22.5%)
IB2	122 (18.4%)
IB3	91 (13.8%)
IIA1	54(8.2%)
IIA2	59 (8.9%)
IIIC1P	171 (25.8%)
IIIC2P	16 (2.4%)

Abbreviations: DSI, Depth of stromal invasion; LVSI, lymphovascular space invasion; SM, surgical margin; PI, parametrial invasion; RT, radiotherapy; CCRT, concurrent chemoradiotherapy; FIGO, International Federation of Gynecology and Obstetrics.

Table 2 Risk factors in different FIGO 2018 stages

	Risk factor, n (%)
FIGO2018 stage	Large tumor	DSI	LVSI	LNM	PI	Positive SM
IB1	0 (0)	13 (8.7)	22 (14.8)	0	0	1 (0.7)
IB2	0 (0)	55 (45.1)	50 (41.0)	0	0	2 (1.6)
IB3	52 (100.0)	35 (67.3)	19 (36.5)	0	2 (3.8)	3 (5.8)
IIA1	0	41 (44.1)	23 (24.7)	0	1 (1.1)	5 (5.4)
IIA2	59 (100.0)	50 (84.8)	26 (44.1)	0	2 (3.4)	3 (5.1)
IIIC1P	74 (43.3)	144 (84.2)	133 (77.8)	171 (100.0)	9 (5.3)	2 (1.2)
IIIC2P	5 (21.3)	15 (93.8)	15 (93.8)	16 (100.0)	2 (12.5)	0 (0)

Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; DSI, depth of stromal invasion; LVSI, lymphovascular space invasion; LNM, lymph node metastasis; PI, parametrial invasion; SM, surgical margin.

Table 3 Distribution of stages by FIGO 2009 and FIGO 2018 criteria

FIGO 2009 stage	FIGO 2018 stage
IB1	IB2	IB3	IIA1	IIA2	IIIC1P	IIIC2P
IB1	149 (44.3%)	122 (36.3%)	0	0	0	58 (17.3%)	7 (2.1%)
IB2			52 (52.5%)	0	0	44 (44.5%)	3 (3.0%)
IIA1	0	0	0	93 (71.5%)	0	33 (25.4%)	4 (3.1%)
IIA2	0	0	0	0	59 (60.8%)	36 (37.1%)	2 (2.1%)

Abbreviation: FIGO, International Federation of Gynecology and Obstetrics.

Figure 1 (A and B) PFS and OS curves for 2018 FIGO stages. (C and D) PFS and OS curves for patients with different numbers of metastatic PLNs.

Abbreviations: OS, overall survival; PFS, progress-free survival; RT, radiotherapy; FIGO, International Federation of Gynecology and Obstetrics; PLN, pelvic lymph node.

Table 4 Results of univariate analysis

Variable	OS			PFS
HR	95% CI	p value	HR	95%CI	p value
Tumor size (>4 cm vs. ≤4.0 cm)	1.535	0.959-2.455	0.074	1.586	1.029-2.446	0.037
DSI (>1/2 vs. ≤1/2)	2.269	1.382-3.725	0.001	2.397	1.510-3.806	<0.001
LVSI (positive vs. negative)	2.106	1.329-3.336	0.002	2.143	1.400-3.279	<0.001
SM (positive vs. negative)	3.181	1.283-7.884	0.012	2.714	1.101-6.695	0.030
PI (positive vs. negative)	0.532	0.074-3.824	0.530	0.939	0.231-3.815	0.930
Histologic type (adenocarcinoma and adenosquamous carcinoma vs. SCC)	1.074	0.591-1.952	0.815	1.139	0.663-1.958	0.636
2018 FIGO stage
IB2 vs. IB1	1.402	0.508-3.867	0.514	1.494	0.619-3.606	0.372
IB3 vs. IB1	2.103	0.667-6.627	0.204	2.003	0.713-5.629	0.187
IIA1 vs. IB1	2.079	0.774-5.583	0.146	1.621	0.644-4.085	0.305
IIA2 vs. IB1	3.022	1.095-8.334	0.033	2.656	1.054-6.692	0.038
IIIC1P vs. IB1	4.170	1.836-9.471	0.001	3.811	1.836-7.912	<0.001
IIIC2P vs. IB1	13.902	5.037-38.368	<0.001	13.440	5.325-33.920	<0.001

Abbreviations: OS, Overall survival; PFS, progression-free survival; DSI, depth of stromal invasion; LVSI, lymphovascular space invasion; SM, surgical margin; PI, parametrial invasion; SCC, squamous cell carcinoma; FIGO, International Federation of Gynecology and Obstetrics.

Table 5 Results of multivariate analysis

Variable	OS			PFS
	HR	95% CI	p value	HR	95% CI	p value
Tumor size (≥4 cm vs. <4.0 cm)	1.047	0.580-1.890	0.879	0.950	0.504-1.791	0.874
DSI (>1/2 vs. ≤1/2)	1.398	0.794-2.462	0.246	1.262	0.692-2.300	0.448
LVSI (positive vs. negative)	1.247	0.749-2.076	0.396	1.236	0.711-2.148	0.453
SM (positive vs. negative)	3.249	1.279-8.249	0.013	3.697	0.711-2.148	0.007
PI (positive vs. negative)	0.418	0.100-1.752	0.233	0.251	0.034-1.84	0.174
Histologic type (adenocarcinoma and adenosquamous carcinoma vs. SCC)	1.081	0.621-1.881	0.784	1.036	0.562-1.910	0.911
FIGO 2018 stage
IB2 vs. IB1	1.204	0.481-3.013	0.692	1.180	0.414-3.367	0.757
IB3 vs. IB1	1.428	0.428-4.765	0.562	1.704	0.454-6.398	0.430
IIA1 vs. IB1	1.293	0.494-3.382	0.600	1.703	0.610-4.754	0.310
IIA2 vs. IB1	1.763	0.556-5.588	0.336	2.390	0.683-8.364	0.173
IIIC1P vs. IB1	2.597	1.055-6.393	0.038	3.246	1.202-8.763	0.020
IIIC2P vs.IB1	9.773	3.340-25.598	<0.001	11.588	3.594-37.358	<0.001

Abbreviations: OS, Overall survival; PFS, progression-free survival; DSI, depth of stromal invasion; LVSI, lymphovascular space invasion; SM, surgical margin; PI, parametrial invasion; SCC, squamous cell carcinoma; FIGO, International Federation of Gynecology and Obstetrics.