FIGO classification 2018: Validation study in patients with locally advanced cervix cancer treated with chemo-radiation.

Abstract Purpose International Federation of Gynecology and Obstetrics in 2018 proposed a new staging for cervical cancer. The present study was designed to reclassify patients with locally advanced cervix cancer performs comparative evaluation With FIGO 2009 Methods Patients with locally advanced cervical cancer (Stage IB2-IVA) who had baseline cross sectional imaging and received (chemo) radiation and brachytherapy were included. Survival outcomes were analyzed according to FIGO 2009. Patients were then reclassified according to FIGO 2018 and TNM classification outcomes were analyzed. FIGO stage and known prognostic factors were included in univariate analysis and multivariate analysis was performed to investigate prognostic value of clinical stage. Results Six hundred and thirty two patients were included. Overall, 185 (29.3%) patients had pelvic adenopathy, while 51 (8.2%) had positive para-aortic nodes. At a median follow up of 33 months, 116 (18.3%) patients had recurrence. 3 year DFS, according to FIGO 2009 for stage IB, IIA, IIB, IIIA, IIIB and IVA were 86%, 91%, 76%, 57%, 65% and 61% respectively. The 3 year DFS after re-staging according to FIGO 2018 for stage IB, IIA, IIB, IIIA, IIIB, IIIC1, IIIC2 and IVA were 100%, 93%, 84%, 53%, 77%, 74%, 61% and 61% respectively. Patients with clinically significant lymphadenopathy had inferior outcomes than node negative patients (62.9% vs 77.8% p = 0.002). Patients with ≥3 para-aortic nodes had poorer DFS than patients with 30cc had worse 3 year DFS than those with primary tumour volume≤30cc (67.4% vs 78.5% p=0.002). Conclusion FIGO 2018 modification is associated with heterogenous outcomes in node positive patients that is affected by primary tumour and nodal volume. We propose a modification to existing TNM staging system to allow more robust classification of outcomes.