Is Tumor Size a Predictor of Survival in Stage IIA Cervical Cancer? A Comparison Between the Old and the New FIGO Staging Criteria

Objectives: In light of studies suggesting that tumor size is a prognostic factor for Stage IIA cervical cancers, FIGO revised the cervical cancer staging criteria, subdividing Stage IIA into Stages IIA1 and IIA2, based on tumor size (4cm). This study aims to determine if the new sub-staging has any impact on overall survival as well as elucidate any other prognostic factors and treatment patterns in this category of patients. Materials and Methods: This is a case series of women diagnosed with Stage IIA cervical cancer in KK Women's & Children's Hospital between 2001 and 2005. Statistical analysis was performed with SPSS version 19. Results: A total of 66 patients were diagnosed with Stage IIA cervical cancer between 2001 and 2005. Of the 50 patients which met the inclusion criteria, 35 (70%) had stage IIA1 and 15 (30%) had Stage IIA2 cervical cancer. The overall 5 year survival was not significantly different between Stage IIA1 and IIA2 (79.6% vs 73.3%, p=0.9). Likewise, progression free survival was not significantly different between Stage IIA1 and IIA2 (76% vs 80%, p=0.86). Patients who underwent radical hysterectomy performed better than those treated by primary radiotherapy (87% vs 69.6%, p=0.043). Cox regression analysis showed that age, tumor grade, histology types, tumor size and lymph node status were not independent predictors of survival. Conclusion: Our preliminary results did not find any difference in overall survival based on the new FIGO sub-staging of IIA1 and IIA2. Larger studies are needed to confirm this finding.