comparison of figo and tnm staging in embrace i...t1b1 n0 m0 = 5 %g t2b n1 m1 = 4 % stage m1a =...

Department of Radiation Oncology / J.Knoth

Comparison of FIGO and TNM Staging in EMBRACE I

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Comparison of FIGO and TNM Staging in

EMBRACE I Johannes Knoth

Department of Radiation Oncology

Medical University of Vienna

FIGO



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• established in 1928

• strictly clinical staging system

• contains:

• clinical examination

• rectoscopy

• cystoscopy

• (lymphography)

TNM



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• established 1950

• local staging same as in FIGO

• advantage in lymph node and metastasis staging

• Imaging and surgery is taken into account:

• CT

• MRI

• PET-CT

• Lymphadenectomy

Project aims



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1. Which FIGO stages are present in the EMBRACE I population?

2. Which TNM stages are present?

3. Which prognostic stages are present?

4. Differences between clinical examination and MRI in local tumor

assessment

5. What is the difference between clinical examination and MRI in

detecting vaginal infiltration?

Status at Diagnosis



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Status at Diagnosis



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Which FIGO stages are present in EMBRACE I ?



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FIGO stages in EMBRACE I



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FIGO IB1 141/1338 10,5 % FIGO I 264/1338 19,7 %

FIGO IB2 123/1338 9,2 %

FIGO IIA1 39/1338 2,9 % FIGO II 838/1338 62,6 %

FIGO IIA2 44/1338 3,3 %

FIGO IIB 755/1338 56,4 %

FIGO IIIA 15/1338 1,1 % FIGO III 206/1338 15,4 %

FIGO IIIB 191/1338 14,3 %

FIGO IVA 30/1338 2,2 % FIGO IV 30/1338 2,2 %

Which TNM stages are present in EMBRACE I ?



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TNM stages in EMBRACE I



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T1b1 N0 M0 67/1338 5,0 %

T1b1 N1 M0 35/1338 2,6 %

T1b1 N1 M1 3/1338 0,2 %

T1b2 N0 M0 42/1338 3,1 %

T1b2 N1 M0 55/1338 4,1 %

T1b2 N1 M1 5/1338 0,4 %

T2a1 N0 M0 20/1338 1,5 %

T2a1 N1 M0 6/1338 0,4 %

T2a1 N1 M1 2/1338 0,2 %

T2a2 N0 M0 27/1338 2,0 %

T2a2 N1 M0 18/1338 1,4 %

T2a2 N1 M1 2/1338 0,2 %

T2b N0 M0 414/1338 31,0 %

T2b N0 M1 4/1338 0,3 %

T2b N1 M0 360/1338 26,9 %

T2b N1 M1 56/1338 4,2 %

T3a N0 M0 5/1338 0,4 %

T3a N1 M0 5/1338 0,4 %

T3a N1 M1 2/1338 0,2 %

T3b N0 M0 39/1338 2,9 %

T3b N0 M1 1/1338 0,1 %

T3b N1 M0 69/1338 5,2 %

T3b N1 M1 16/1338 1,2 %

T4a N0 M0 27/1338 2,0 %

T4a N1 M0 48/1338 3,6 %

T4a N1 M1 10/1338 0,8 %

1 T2b N0 M0 = 31 %%

T2b N1 M0 = 27 %

gT3b N1 M0 = 5 %

T1b1 N0 M0 = 5 %g

T2b N1 M1 = 4 %

Stage M1a

= 101/1338

(7,6 %)

Which prognostic stages are present in EMBRACE I ?



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Prognostic stages (AJCC/UICC)



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Stadium IB1 67/1338 5,0 % Stadium I 109/1338 8,2 %

Stadium IB2 42/1338 3,1 %

Stadium IIA1 20/1338 1,5 % Stadium II 461/1338 34,5 %

Stadium IIA2 27/1338 2,0 %

Stadium IIB 414/1338 31,0 %

Stadium IIIA 5/1338 0,4 % Stadium III 592/1338 44,3 %

Stadium IIIB 587/1338 43,9 %

Stadium 4A 75/1338 5,6 % Stadium IV 176/1338 13,2 %

Stadium 4B 101/1338 7,6 %

Differences between clinical examination and MRI in local tumor assessment



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Comparison of local staging



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• Difference in 388/1338 patients (28,9 %)

• 141/1338 (10,5 %) lower stage in MRI than in clinical examination

• 247/1338 (18,5 %) higher stage in MRI than in clinical examination

Comparison of local staging



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T imaging

1b1 1b2 2a1 2a2 2b 3a 3b 4a Total

IB1 0 24 4 0 43 0 0 0 71

IB2 9 0 0 4 40 0 4 0 57

IIA1 4 0 0 15 8 0 0 0 27

FIGO IIA2 1 4 4 0 15 1 0 2 27

clinical IIB 22 8 7 8 0 2 28 20 95

IIIA 0 0 1 1 3 0 0 2 7

IIIB 0 0 0 2 62 1 0 35 100

IVA 0 0 0 0 2 0 2 0 4

Total 36 36 16 30 173 4 34 59 388

Tumor (clinical)

Tumor MRI

What is the difference between clinical examination and MRI in detecting

vaginal infiltration?



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Vaginal infiltration in MRI



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• 599/1338 (44,8%) patients with clinical infiltration of the vagina

• 507/599 (84,6 %) also detected in MRI

Summary



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• FIGO and TNM stages in EMBRACE I captured

• FIGO: largest group Stage II (63 %)

• TNM: largest group T2b N0/N1 M0 (58 %)

• Prognostic staging: largest group Stage III (44 %)

• Tendency of stage migration to higher stages in MRI compared to clinical

examination

• Further analyses ongoing

comparison of figo and tnm staging in embrace i...t1b1 n0 m0 = 5 %g t2b n1 m1 = 4 % stage m1a =...

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