Simona Stolnicu1, Lien Hoang2, Noorah Almadani2, Louise De Brot3, Graziele Bovolim3, Glauco Baiocchi4, Maria Jose Brito5, Georgia Karpathiou6, Antonio Ieni7, Esther Guerra Fernandez8, Takako Kyiokawa9, Pavel Dundr10, Carlos Parra-Herran11, Sofia Lérias12, Ana Felix12, Andres Roma13, Anna Pesci14, Esther Oliva15, Robert A Soslow16, Nadeem R Abu-Rustum17, Kay J Park16. 1. Department of Pathology, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540139, Targu Mures, Romania. stolnicu@gmx.net. 2. Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada. 3. Department of Pathology, A.C.Camargo Cancer Center, São Paulo, Brazil. 4. Department of Surgical Oncology, A.C.Camargo Cancer Center, São Paulo, Brazil. 5. Department of Pathology, Hospital Garcia de Orta, Almada, Portugal. 6. Department of Pathology, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France. 7. Department of Human Pathology, University of Messina, Messina, Italy. 8. Department of Pathology, Hospital Universitari de Bellvitge-IDIBELL, Barcelona, Spain. 9. Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan. 10. Department of Pathology, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic. 11. Brigham and Women's Hospital, Boston, MA, USA. 12. Instituto Portugues de Oncologia, Lisbon, Portugal. 13. University of California San Diego, San Diego, USA. 14. IRCSS Ospedale Sacro Cuore Don Calabria, Negrar, Italy. 15. Massachusetts General Hospital, Boston, MA, USA. 16. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA. 17. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
Abstract
PURPOSE: The 2018 International Federation of Gynecology and Obstetrics (FIGO) update on cervical cancer staging eliminated horizontal tumor extent (HZTE) as a staging parameter in stage IA (microscopic) disease. We aimed to determine whether HZTE correlates with outcomes in early stage ECAs and FIGO should reinstate HZTE as a staging parameter in futures updates. METHODS: We retrospectively analyzed 416 FIGO 2009 stage I ECAs from 17 institutions and re-assigned stage using FIGO 2018. Correlation between HZTE, overall (OS) and recurrence free survival (RFS) was performed using univariable and multivariable analyses. RESULTS: Re-staging 416 cases resulted in 126 (30.3%) IA and 290 (69.7%) IB cases; 85 (67.5%) IA tumors had HZTE ≤ 7 mm, while 41 (32.5%) were > 7 mm; 32 (11%) IB tumors had HZTE ≤ 7 mm, while 258 (89%) were > 7 mm (p = 0.0001). Four (3.2%) IA (1 IA1, 3 IA2) patients developed recurrence (3 ≤ 7 mm, 1 > 7 mm) compared to 41 (14.1%) IB patients (p = 0.002). Fourteen IB and no IA patients died of disease (8 IB1, 1 ≤ 7 mm). Cox univariate analysis demonstrated that only RFS is significantly influenced by HZTE (p = 0.01), while OS and RFS were not influenced by HZTE on multivariate analysis. CONCLUSION: HZTE has limited prognostic value in early stage ECAs and is only associated with RFS on univariate but not multivariate analysis. HZTE does not improve prognostication of patients with stage I ECAs as per 2018 FIGO staging. Consequently, the rationale to remove this variable from FIGO staging is justified for ECAs.
PURPOSE: The 2018 International Federation of Gynecology and Obstetrics (FIGO) update on cervical cancer staging eliminated horizontal tumor extent (HZTE) as a staging parameter in stage IA (microscopic) disease. We aimed to determine whether HZTE correlates with outcomes in early stage ECAs and FIGO should reinstate HZTE as a staging parameter in futures updates. METHODS: We retrospectively analyzed 416 FIGO 2009 stage I ECAs from 17 institutions and re-assigned stage using FIGO 2018. Correlation between HZTE, overall (OS) and recurrence free survival (RFS) was performed using univariable and multivariable analyses. RESULTS: Re-staging 416 cases resulted in 126 (30.3%) IA and 290 (69.7%) IB cases; 85 (67.5%) IA tumors had HZTE ≤ 7 mm, while 41 (32.5%) were > 7 mm; 32 (11%) IB tumors had HZTE ≤ 7 mm, while 258 (89%) were > 7 mm (p = 0.0001). Four (3.2%) IA (1 IA1, 3 IA2) patients developed recurrence (3 ≤ 7 mm, 1 > 7 mm) compared to 41 (14.1%) IB patients (p = 0.002). Fourteen IB and no IA patients died of disease (8 IB1, 1 ≤ 7 mm). Cox univariate analysis demonstrated that only RFS is significantly influenced by HZTE (p = 0.01), while OS and RFS were not influenced by HZTE on multivariate analysis. CONCLUSION: HZTE has limited prognostic value in early stage ECAs and is only associated with RFS on univariate but not multivariate analysis. HZTE does not improve prognostication of patients with stage I ECAs as per 2018 FIGO staging. Consequently, the rationale to remove this variable from FIGO staging is justified for ECAs.
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