Staging locally advanced cervical cancer with FIGO 2018 versus FIGO 2008: Impact on overall survival and progression-free survival in the OUTBACK trial (ANZGOG 0902, RTOG 1174, NRG 0274).

Authors

null

Linda R. Mileshkin

Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia

Linda R. Mileshkin , Kathleen N. Moore , Elizabeth H Barnes , Yeh Chen Lee , Val Gebski , Kailash Narayan , Nathan Bradshaw , Katrina Diamante , Anthony W. Fyles , William Small Jr., David K. Gaffney , Pearly Khaw , Susan Brooks , J Spencer Thompson , Warner King Huh , Matthew Carlson , Katina Robison , Danny Rischin , Martin R. Stockler , Bradley J. Monk

Organizations

Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia, Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada, Loyola University Medical Center, Maywood, IL, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, Auckland Hospital, Auckland, New Zealand, Radiation Oncology, OU Health, University of Oklahoma, Oklahoma City, OK, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, UT Southwestern Medical Center, Dallas, TX, Women and Infants Hospital in Rhode Island, Providence, RI, Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia, Division of Gynecologic Oncology, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ

Research Funding

Other Government Agency

Background: The International Federation of Obstetrics and Gynecology staging system for cervical cancer (FIGO 2008) was revised in 2018 to incorporate lymph node involvement (FIGO 2018). OUTBACK is an international, randomized phase 3 trial of adjuvant chemotherapy versus observation after standard of care treatment with chemoradiation for women with locally advanced cervical cancer. OUTBACK found no benefit from the addition of adjuvant chemotherapy. We evaluated the effects of classifying participants with these 2 staging systems in the OUTBACK trial population. Methods: OUTBACK recruited April 2011 to June 2017 and staged participants according to FIGO 2008. Lymph node status, smoking status, age, race and histological subtype were documented at trial entry as important prognostic factors. We assessed the effects of stage grouping into stage I, II, and III/IVa with FIGO 2008 versus FIGO 2018, on progression-free survival (PFS) and overall survival (OS) at 5 years using Kaplan-Meier estimates, and in univariable proportional-hazards regression analyses, and in multivariable analyses adjusting for important prognostic factors and randomly allocated treatment. Results: All 919 study participants had complete data for staging according to the 2 staging systems and most prognostic factors for adjustment. Among all participants, the 5-year outcomes were PFS = 62% and OS = 72%. Classification according to FIGO 2018 rather than FIGO 2008 yielded higher 5-year PFS and OS in each stage group (see table for numbers of participants, PFS and OS for each stage group). Predictors of PFS in multivariable analysis included squamous vs non-squamous histology (HR 0.71 for FIGO 2008 and 0.74 for FIGO 2018), but not nodal involvement when FIGO 2018 was used. Both staging systems were the only independently significant prognostic factors in both univariable and multivariable analyses (all p < 0.0001) for both PFS and OS. Conclusions: Compared to FIGO 2008, reclassifying pts by FIGO 2018 staging resulted in more pts being classified as stage 3 due to the incorporation of nodal status. Staging locally advanced cervical cancer using FIGO 2018 rather than FIGO 2008 resulted in higher PFS and OS in each stage grouping that reflected stage migration, not a true improvement in outcomes. FIGO stage remains the strongest predictor of overall survival after CRT but survival outcomes by stage in trials using the old vs new staging system are not comparable. Clinical trial information: ACTRN12610000732088.

Number (%)
Number (%)
PFS 5Y %

OS 5Y %
Stage Group
FIGO 08
FIGO 18
FIGO 08
FIGO 18

FIGO 08
FIGO 18
I
242 (26%)
105 (12%)
71
81

78
89
II
457 (50%)
261 (28%)
65
68

75
78
III/IVa
220 (24%)
553 (60%)
48
56

58
66

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gynecologic Cancer

Track

Gynecologic Cancer

Sub Track

Cervical Cancer

Clinical Trial Registration Number

ACTRN12610000732088

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr 5531)

DOI

10.1200/JCO.2022.40.16_suppl.5531

Abstract #

5531

Poster Bd #

410

Abstract Disclosures