Comparison of FIGO 2009 and 2018 Staging of Cervical Cancer and Its Impact on Post-operative Adjuvant Therapy

Abstract

Objective: To compare pre-operative and post-operative staging in early-stage cervical cancer as per the FIGO 2009 and 2018 staging system
Methods: This retrospective study was conducted on cervical cancer cases treated surgically over five years in a tertiary care teaching hospital after approval from the IEC and written informed consent. Out of the total 99 cases identified in records, 93 were managed by the FIGO 2009 staging system and 6 by the FIGO 2018 staging system. Records were searched to tabulate demographic details, pre-op stage as per clinical and radiological findings and post op stage as per histological details, both by 2009 and 2018 staging systems. Pre op and post op stage distribution by two systems was compared using the kappa score and statistical significance was assessed by p-value using SPSS version 20.
Results: The majority of early-stage cervical cancer cases were in the 40 to 60 years age group, had early age at marriage and were multiparous menopausal women. The cervical growth was mostly exophytic, well-differentiated, squamous cell type on histology. Agreement between the pre-operative stage by the FIGO 2009 and 2018 staging systems was poor (38.7%, k = 0.243 (Poor) (p <0.001). The comparison of pre-operative and post-operative staging by the FIGO 2009 system shows moderate agreement (77.41%, k = 0.555) (p <0.001), while that by the 2018 system showed substantial agreement (81.8%, k=0.774) (p <0.001).
Conclusion: The FIGO 2018 staging system is more accurate compared to the 2009 staging system when comparing prep and post op staging of disease.