Treatment Outcomes of Early Carcinoma Cervix Before and After Sub-specialization

Influence of New FIGO 2018 Staging on Treatment Outcomes in Early-Stage Cervical Cancer: A Single-Center Study

Satinder KaurPurpose  The aim of this article was to study survival outcomes of early-stage cervical cancer patients and impact on survival after restaging them as per International Federation of Gynecology and Obstetrics (FIGO) 2018. Materials and Methods  A retrospective study was conducted from June 1, 2013 to May 31, 2018 in a tertiary care hospital in North India. One-hundred patients of early-stage cervical cancer (as per FIGO 2009 staging) who had been treated by surgery followed by risk based tailored adjuvant therapy in our hospital were evaluated. The clinicopathological features and survival outcomes of these patients were analyzed. These patients were then restaged as per new FIGO 2018 staging and survival outcomes between two FIGO classifications were compared. Results  The median age of the study population was 52.5 years with median follow-up of 62.1 months. Ninety percent of our patients had more than 2 years follow-up and 59% had more than 5 years follow-up. The overall survival and relapse-free survival were 87.5 and 91.4%, respectively. The study population was then reclassified according to new FIGO 2018 staging. It was seen that the patients with stage IB1and IB2 cervical cancer had overall survival of 91.1 and 90%, respectively. The overall survival of stage IB3 was 80% and the survival of stage IIIC1 was only 60%. Conclusion  The new FIGO 2018 classification has a significant effect on survival outcome and in prognostication of patients with cervical cancer.

Assessment of ESGO Quality Indicators in Cervical Cancer Surgery: A Real-World Study in a High-Volume Chinese Hospital

The ESGO developed a list of fifteen quality indicators for cervical cancer surgery in order to audit and improve clinical practice in 2020. However, data from the developing countries with high incidence rates of cervical cancer is still lacking. Therefore, we conducted a retrospective study of 7081 cases diagnosed as cervical cancer between 2014 and 2019 in a Chinese single center according to the quality indicators proposed by ESGO. A total of 5952 patients underwent radical procedures, with an average of 992.0 per year. All surgeries were performed or supervised by a certified gynecologic oncologist as surgical qualification grading system has been established. Compared with the low-volume group, patients in the high-volume group (≥15 cases/year) had a shorter hospital stay (P<0.001), more free surgical margins (P=0.031), and less complications (P<0.001), but the 5-year recurrence-free survival and overall survival rates were similar (P>0.05). Treatment was not planned at a multidisciplinary team meeting but with the consultation system. The required preoperative workup was incomplete in 19.7% of patients with pelvic MRI and 45.7% of patients with PET-CT. A total of 1459 (20.6%) patients experienced at least one complication after surgery. The CDC grade IIIb or higher complications occurred in 80 patients, accounting for 5.5% complications. The urological fistula rate within 30 postoperative days were 0.3%. After primary surgical treatment, 97.4% patients had clear vaginal and parametrial margins. After restaging FIGO 2009 to FIGO 2018 system, 14.7% patients with a stage T1b disease were T-upstaged. After a median follow-up of 42 months, recurrence occurred in 448 patients, and 82.1% patients recurred within 2 years. The 2-year RFS rate of patients with pT1b1N0 was 97.3% in 2009 FIGO staging system. Lymph node staging was performed in 99.0% patients with a stage T1 disease. After a primary surgical treatment for a stage pT1b1N0 disease, 28.3% patients received adjuvant chemoradiotherapy. Above all, most of quality indicators reached the targets, except four quality indicators. The quality indicators of ESGO should be popularized and applied in China to guarantee quality of surgery.