FIGO 2018 Versus Ontogenetic Staging for Locally Advanced Cervical Cancer: An International Multicenter Cohort Study...

Area of Science:

• Gynecologic Oncology
• Radiotherapy Oncology
• Medical Imaging

Background:

• Locally advanced cervical cancer requires accurate prognostic tools.
• Current staging systems, like FIGO 2018, may have limitations in predicting outcomes.
• The ontogenetic tumor staging system is a newer approach for evaluating cervical cancer progression.

Purpose of the Study:

• To compare the prognostic performance of the ontogenetic tumor staging system against the FIGO 2018 staging system for cervical cancer.
• To determine which staging system better predicts oncological outcomes in patients treated with chemoradiotherapy.

Main Methods:

• A multicenter retrospective cohort study included 341 patients with locally advanced cervical cancer (FIGO 2018 stages IIB-IVA).
• Patients received primary chemoradiotherapy.
• Comparison of prognostic accuracy for cancer-specific survival, recurrence-free survival, and overall survival using statistical models and metrics like Harrell's C-index and AUC.

Main Results:

• The ontogenetic tumor staging system demonstrated superior prognostic performance over the FIGO 2018 system.
• Kaplan-Meier curves showed clear survival separation with ontogenetic staging, unlike overlapping curves with FIGO 2018.
• Multivariable Cox models and statistical comparisons confirmed the ontogenetic model's better discriminative ability and fit, providing significant risk stratification within subgroups.

Conclusions:

• Ontogenetic tumor staging, applicable via imaging alone, is superior to FIGO 2018 classification for locally advanced cervical cancer.
• This finding supports the use of ontogenetic staging for improved prognostic assessment and treatment planning.