J Gynecol Oncol.
2022 May;33(3):e26. 10.3802/jgo.2022.33.e26.
Significance of histology and nodal status on the survival of women with early-stage cervical cancer: validation of the 2018 FIGO cervical cancer staging system
- Machida H
1 - Matsuo K2,3
- Kobayashi Y4
- Momomura M4
- Takahashi F5
- Tabata T6
- Kondo E7
- Yamagami W8
- Ebina Y9
- Kaneuchi M10
- Nagase S11
- Mikami M1
- Affiliations
-
- 1Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan
- 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
- 3Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- 4Department of Obstetrics and Gynecology, Kyorin University, Tokyo, Japan
- 5Division of Medical Engineering, Department of Information Science, Iwate Medical University, Morioka, Japan
- 6Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo, Japan
- 7Department of Obstetrics and Gynecology, Mie University, Mie, Japan
- 8Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
- 9Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- 10Department of Obstetrics and Gynecology, Otaru General Hospital, Hokkaido, Japan
- 11Department of Obstetrics and Gynecology, Yamagata University, Yamagata, Japan
- KMID: 2536989
- DOI: http://doi.org/10.3802/jgo.2022.33.e26
Abstract
Objective
To assess the efficacy of the FIGO 2018 classification system for nodal-specific classifications for early-stage cervical cancer; specifically, to examine the impact of nodal metastasis on survival and the effect of postoperative treatments, according to histological subtypes.
Methods
This society-based retrospective observational study in Japan examined 16,539 women with the 2009 FIGO stage IB1 cervical cancer who underwent primary surgical treatment from 2004 to 2015. Associations of cause-specific survival (CSS) with nodal metastasis and postoperative adjuvant therapy were examined according to histology type (squamous cell carcinoma [SCC], n=10,315; and non-SCC, n=6,224).
Results
The nodal metastasis rate for SCC was higher than that for non-SCC (10.7% vs. 8.3%, p<0.001). In multivariable analysis, the impact of nodal metastasis on CSS was greater for non-SCC tumors (adjusted-hazard ratio [HR], 3.11; 95% confidence interval [CI], 2.40–4.02) than for SCC tumors (adjusted-HR, 2.20; 95% CI, 1.70–2.84; p<0.001). Propensity score matching analysis showed significantly lower CSS rates for women with pelvic nodal metastasis from non-SCC tumors than from SCC tumors (5-year CSS rate, 75.4% vs. 90.3%, p<0.001). The CSS rates for women with nodal metastasis in SCC histology were similar between the postoperative concurrent chemoradiotherapy/radiotherapy and chemotherapy groups (89.2% vs. 86.1%, p=0.42), whereas those in non-SCC histology who received postoperative chemotherapy improved the CSS (74.1% vs. 67.7%, p=0.043).
Conclusion
The node-specific staging system in the 2018 FIGO cervical cancer classification is applicable to both non-SCC tumors and SCC tumors; however, the prognostic significance of nodal metastases and efficacy of postoperative therapies vary according to histology.
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