Staging early cervical cancer in China: data from a multicenter collaborative

Abstract

BackgroundIn 2018 the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system of cervical cancer. This study aimed to assess the quality of staging early cervical cancer in China before the revision.MethodsThis multicenter retrospective study included 34 tertiary hospitals in China. Medical records of patients with cervical cancer who underwent primary surgical treatment between January 2010 and December 2015 were reviewed retrospectively. All patients were clinically staged according to the 2009 FIGO staging system. Eligibility criteria included: histopathologically confirmed cervical cancer; 2009 FIGO stage IA–IIA2 based on 2009 FIGO staging system; primary surgical treatment including extrafascial, type II or type III radical hysterectomy; radical trachelectomy; with or without pelvic lymphadenectomy; regardless of surgical route via laparotomy or laparoscopy; and complete clinical and pathological data. Patients who received non-surgical treatment, neoadjuvant treatment, or those with incomplete data were excluded. The accuracy of clinical staging was assessed by comparison between clinical and pathologic stage using the latter as the reference standard.ResultsA total of 23 933 cases of cervical cancer were identified and 12 681 fulfilled the inclusion criteria. Of these patients, 69.6% were staged accurately, 9.4% were clinically understaged, and 21.0% were clinically overstaged. The accuracy of stage IA, IB1, IB2, IIA1, and IIA2 was 90.0%, 87.5%, 57.4%, 20.3%, and 25.5%, respectively. The causes of stage inaccuracy were as follows: vaginal involvement (62.3%), maximal tumor diameter (24.6%), extent of cervical stromal invasion (7.1%), parametrial invasion (5.8%), bladder or rectal infiltration (0.1%), and distant metastases (0.1%).ConclusionThe accuracy of staging early cervical cancer in China was suboptimal before the revision of the staging system, especially for IIA1 and IIA2. The most common reasons for staging inaccuracy were vaginal involvement and tumor diameter.

Measurement of tumor size in early cervical cancer: an ever-evolving paradigm

“…The authors concluded that the quality of staging cervical cancer was suboptimal before the integration of advanced imaging techniques as currently proposed by the 2018 FIGO staging system. 18 The evidence thus suggests that clinical examination, although a standard and necessary step in the initial evaluation of patients with cervical cancer, is limited in its ability to reliably ascertain tumor size with accuracy. It is imperative that in addition to the pelvic examination, tools such as imaging studies are used to complement the information gathered in designating stage and implementing management strategy (Table 1).…”

Hazard Ratio Analysis of Laparoscopic Radical Hysterectomy for IA1 With LVSI-IIA2 Cervical Cancer: Identifying the Possible Contraindications of Laparoscopic Surgery for Cervical Cancer

“…Clinical data were collected from patient files and the medical record management system in the hospitals by trained gynecological oncology staff using standardized data collection and quality control procedures. The details of the data sources and methods were the same as previously reported ( 22 , 23 ). For patients undergoing surgical treatment, the collected data, including the demographic details, preoperative examination results, surgical information, pathological results, preoperative, and postoperative adjuvant treatment details, complications, hospitalization time, and expenses, and follow-up, contained almost all the information during the treatment of cervical cancer.…”

Effect of pre‐operative radiotherapy on long‐term outcomes among women with Stage IB1 to IIB cervical squamous cell carcinoma

“…The C4 survey database comprises data on a total of 46 313 women with cervical cancer who were treated between January 1, 2004, and December 31, 2016, in 37 medical institutions in mainland China. Details of the data collection strategy have been described in previous studies 13‐16 . In brief, data collection was carried out by gynecologists using the medical record management system of each hospital.…”