Scolaris Content Display Scolaris Content Display

Histerectomía con radioterapia o quimioterapia o ambas para mujeres con cáncer de cuello uterino localmente avanzado

Appendices

Appendix 1. FIGO staging classification for cervical cancer

Stage

Characteristics

I

The carcinoma is strictly confined to the cervix (extension to the corpus should be disregarded).

IA

Invasive cancer identified only microscopically. All gross lesions, even with superficial invasion, are Stage IB cancers. Invasion is limited to a measured stromal invasion with a maximal depth of 5.0 mm and a horizontal extension of ≤ 7.0 mm. Depth of invasion should be ≤ 5.0 mm taken from the base of the epithelium, either surface or glandular, from which it originates. Vascular space involvement, either venous or lymphatic, should not alter the staging.

IA1

Measured stromal invasion of ≤ 3.0 mm in depth and extension of ≤ 7.0 mm.

IA2

Measured stromal invasion of > 3.0 mm and ≤ 5.0 mm in depth with an extension of ≤ 7.0 mm

IB

Clinical lesions confined to the cervix or preclinical lesions > IA. All gross lesions even with superficial invasion are Stage IB cancers

IB1

Clinical lesions ≤ 4 cm in size.

IB2

Clinical lesions > 4 cm in size.

II

The carcinoma extends beyond the cervix, but has not extended onto the pelvic wall; the carcinoma involves the vagina, but not as far as the lower third.

IIA

No obvious parametrial involvement. Involvement of up to the upper two‐thirds of the vagina.

IIB

Obvious parametrial involvement, but not into the pelvic sidewall.

III

The carcinoma has extended onto the pelvic wall; on rectal examination there is no cancer‐free space between the tumour and the pelvic wall; the tumour involves the lower third of the vagina; all cases with a hydronephrosis or non‐functioning kidney should be included, unless they are known to be due to other causes.

IIIA

No extension onto the pelvic wall, but involvement of the lower third of the vagina.

IIIB

Extension onto the pelvic wall or hydronephrosis or non‐functioning kidney.

IV

The carcinoma has extended beyond the true pelvis or has clinically involved the mucosa of the bladder or rectum.

IVA

Spread of the growth to adjacent organs.

IVB

Spread to distant organs.

Appendix 2. CENTRAL search strategy

  1. MeSH descriptor Uterine Cervical Neoplasms explode all trees

  2. (cervi* near/5 (cancer* or neoplas* or carcinom* or malignan* or tumor* or tumour*))

  3. (#1 OR #2)

  4. MeSH descriptor Hysterectomy explode all trees

  5. hysterectom*

  6. (#4 OR #5)

  7. MeSH descriptor Antineoplastic Agents explode all trees

  8. MeSH descriptor Antineoplastic Combined Chemotherapy Protocols explode all trees

  9. MeSH descriptor Chemotherapy, Adjuvant, this term only

  10. chemotherap*

  11. cisplatin

  12. carboplatin

  13. gemcitabine

  14. paclitaxel

  15. etoposide

  16. fluorouracil

  17. bleomycin

  18. ifosphamide

  19. (#7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18)

  20. MeSH descriptor Radiotherapy explode all trees

  21. radiotherap*

  22. radiation

  23. (#20 OR #21 OR #22)

  24. chemoradi* or radiochemo*

  25. (#19 OR #23 OR #24)

  26. (#3 AND #6 AND #25)

Appendix 3. MEDLINE (Ovid) search strategy

  1. exp Uterine Cervical Neoplasms/

  2. (cervi* adj5 (cancer* or neoplas* or carcinom* or malignan* or tumor* or tumour*)).mp.

  3. 1 or 2

  4. exp Hysterectomy/

  5. hysterectom*.mp.

  6. 4 or 5

  7. exp Antineoplastic Agents/

  8. exp Antineoplastic Combined Chemotherapy Protocols/

  9. Chemotherapy, Adjuvant/

  10. chemotherap*.mp.

  11. cisplatin.mp.

  12. carboplatin.mp.

  13. gemcitabine.mp.

  14. paclitaxel.mp.

  15. etoposide.mp.

  16. fluorouracil.mp.

  17. belomycin.mp.

  18. ifosphamide.mp.

  19. 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18

  20. exp Radiotherapy/

  21. radiotherap*.mp.

  22. radiation.mp.

  23. 20 or 21 or 22

  24. (chemoradi* or radiochemo*).mp.

  25. 19 or 23 or 24

  26. 3 and 6 and 25

  27. randomized controlled trial.pt.

  28. controlled clinical trial.pt.

  29. randomized.ab.

  30. placebo.ab.

  31. clinical trials as topic.sh.

  32. randomly.ab.

  33. trial.ti.

  34. 27 or 28 or 29 or 30 or 31 or 32 or 33

  35. 26 and 34

key:

mp = title, original title, abstract, name of substance word, subject heading word, unique identifier
pt = publication type
ab = abstract
sh = subject heading

Appendix 4. Embase (Ovid) search strategy

  1. exp uterine cervix tumor/

  2. (cervi* adj5 (cancer* or neoplas* or carcinom* or malignan* or tumor* or tumour*)).mp.

  3. 1 or 2

  4. exp hysterectomy/

  5. hysterectom*.mp.

  6. 4 or 5

  7. exp antineoplastic agent/

  8. exp chemotherapy/

  9. chemotherap*.mp.

  10. cisplatin.mp.

  11. carboplatin.mp.

  12. gemcitabine.mp.

  13. paclitaxel.mp.

  14. etoposide.mp.

  15. fluorouracil.mp.

  16. belomycin.mp.

  17. ifosphamide.mp.

  18. 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17

  19. exp radiotherapy/

  20. radiotherap*.mp.

  21. radiation.mp.

  22. 19 or 20 or 21

  23. (chemoradi* or radiochemo*).mp.

  24. 18 or 22 or 23

  25. 3 and 6 and 24

  26. crossover procedure/

  27. double‐blind procedure/

  28. randomized controlled trial/

  29. single‐blind procedure/

  30. random*.mp.

  31. factorial*.mp.

  32. (crossover* or cross over* or cross‐over*).mp.

  33. placebo*.mp.

  34. (double* adj blind*).mp.

  35. (singl* adj blind*).mp.

  36. assign*.mp.

  37. allocat*.mp.

  38. volunteer*.mp.

  39. 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38

  40. 25 and 39

key:

[mp = title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

Appendix 5. LILACS search strategy

(MH:hysterectomy or hysterectom$) AND ((cervi$ and (cancer$ or tumor$ or tumour$ or malignan$ or carcinoma$ or neoplas$)) or MH:Uterine Cervical Neoplasms)

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study flow diagram.

Figuras y tablas -
Figure 3

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1: Hysterectomy (radical) with neoadjuvant chemotherapy (NACT) versus chemoradiotherapy alone, Outcome 1: Overall survival

Figuras y tablas -
Analysis 1.1

Comparison 1: Hysterectomy (radical) with neoadjuvant chemotherapy (NACT) versus chemoradiotherapy alone, Outcome 1: Overall survival

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2: Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone, Outcome 1: Overall survival

Figuras y tablas -
Analysis 2.1

Comparison 2: Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone, Outcome 1: Overall survival

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2: Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone, Outcome 2: Disease‐ or progression‐free survival

Figuras y tablas -
Analysis 2.2

Comparison 2: Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone, Outcome 2: Disease‐ or progression‐free survival

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings 1. Hysterectomy (radical) with neoadjuvant chemotherapy versus chemoradiotherapy alone for women with locally advanced cervical cancer

Hysterectomy (radical) with neoadjuvant chemotherapy versus with chemoradiotherapy alone for women with locally advanced cervical cancer

Patient or population: women with locally advanced cervical cancer

Settings: outpatient

Intervention: NACT + hysterectomy

Comparison: CCRT

Outcomes

Relative effect (95% CI)

No. of participants (studies)

Certainty of the evidence(GRADE)

Comments

Overall survival

Median follow‐up 58.5–98.4 months in the 2 trials

HR 0.94 (0.76 to 1.16)

1253

(2 RCTs)

⊕⊕⊕⊝

Moderatea

I2 = 0%

DFS

Median follow‐up 58.5–98.4 months in the 2 trials

HR 1.38 (1.02 to 1.87)

633

(1 RCT)

⊕⊕⊝⊝

Lowb

—

5‐year DFS in the NACT + surgery group was 57% vs 65.6% in the chemoradiotherapy group (P = 0.021)

620

(1 RCT)

Quality of life

—

—

—

Not reported.

SAEs and toxicity

SAEs

In first trial, there were no toxic deaths reported.

198 SAEs occurred: 145 in the NACT + surgery arm vs 53 in the CCRT arm.

In the second trial there were 114 grade 3 or 4 SAEs: 92 in the NACT + surgery arm vs 22 in the CCRT arm

198

(1 RCT)

114

(1 RCT)

⊕⊝⊝⊝

Very lowc

—

Toxicity

In 1 trial, NACT + surgery group, compared with the chemoradiotherapy group, there was a lower rate of rectal (5.7% with NACT + surgery vs 13.3% with chemoradiotherapy; P = 0.002), bladder (2.8% with NACT + surgery vs 7.3% with chemoradiotherapy; P = 0.017), and vaginal (19.9% with NACT + surgery vs 36.9% with chemoradiotherapy; P = 0.001) toxicity occurring or persisting 90 days after treatment completion. However, 24 months after treatment completion, there was no difference in rectal and bladder toxicities between groups, whereas vaginal toxicity continued to occur at a lower rate in the NACT + surgery group (12.0% with NACT + surgery vs 25.6% with chemoradiotherapy; P = 0.001).

114

(1 RCT)

Treatment‐related morbidity

No treatment‐related deaths in either chemoradiotherapy or NACT + surgery arm. Overall, 89% of participants in the chemoradiotherapy arm and 73% in the NACT + surgery arm had complications, with 18% in NACT + surgery arm experiencing recurrence and requiring adjuvant radiotherapy.

111

(1 RCT)

CI: confidence interval; CCRT: concurrent chemoradiotherapy; DFS: disease‐free survival; HR: hazard ratio; NACT: neoadjuvant chemotherapy; SAE: serious adverse event.

GRADE Working Group grades of evidence

High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded one level due to concerns regarding the uncertainty of risk of bias in individual trials and only two trials in meta‐analysis (although it is arguable whether the number of included participants represented relatively sparse data).
bDowngraded two levels due to risk of bias and sparse data.
cDowngraded three levels due to incomplete and poor reporting of important adverse events and toxicities, sparseness of data and risk of bias concerns.

Figuras y tablas -
Summary of findings 1. Hysterectomy (radical) with neoadjuvant chemotherapy versus chemoradiotherapy alone for women with locally advanced cervical cancer
Ir a la tabla de la revisión
Summary of findings 2. Hysterectomy (simple or radical) with neoadjuvant chemotherapy versus radiotherapy alone for women with locally advanced cervical cancer

Hysterectomy (simple or radical) with neoadjuvant chemotherapy versus radiotherapy alone for women with locally advanced cervical cancer

Patient or population: women with locally advanced cervical cancer

Settings: outpatient

Intervention: neoadjuvant chemotherapy + radical hysterectomy

Comparison: radiotherapy alone

Outcomes

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Overall survival

Median follow‐up 39–60 months in the 3 trials

HR 0.71 (0.55 to 0.93)

571
(3 RCTs)

⊕⊕⊕⊝
Moderatea

—

Disease‐ or progression‐free survival

Median follow‐up 39–60 months in the 3 trials

HR 0.75 (0.53 to 1.05)

571
(3 RCTs)

⊕⊕⊕⊝
Moderatea

There were varying definitions of disease‐ and progression‐free survival. However, we did not consider this merited further downgrading to low‐certainty evidence.

Quality of life

—

—

—

Not reported.

Severe adverse events and toxicity

Acute severe toxicity

RR 1.32 (0.47 to 3.71)

118

(1 RCT)

⊕⊕⊝⊝
Lowb

—

Long‐term severe complications

RR 0.86 (0.49 to 1.50)

409

(1 RCT)

Severe late toxicity

RR 0.60 (0.27 to 1.34)

118

(1 RCT)

CI: confidence interval; HR: hazard ratio; RCT: randomised controlled trial; RR: risk ratio.

GRADE Working Group grades of evidence
High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded one level due to concerns regarding the uncertainty of risk of bias in individual trials.
bDowngraded two levels due to incomplete and poor reporting of important adverse events and toxicities and sparseness of data.

Figuras y tablas -
Summary of findings 2. Hysterectomy (simple or radical) with neoadjuvant chemotherapy versus radiotherapy alone for women with locally advanced cervical cancer
Ir a la tabla de la revisión
Summary of findings 3. Hysterectomy (simple or radical) with radiotherapy versus radiotherapy alone

Hysterectomy (simple or radical) with radiotherapy versus radiotherapy alone

Patient or population: women with locally advanced cervical cancer

Settings: outpatient

Intervention: radiotherapy + hysterectomy (simple or radical)

Comparison: radiotherapy alone

Outcomes

Relative effect (95% CI)

No of participants

Certainty of the evidence (GRADE)

Comments

Overall survival

Median follow‐up 9.6 years

HR 0.89 (0.61 to 1.29)

256

(1 RCT)

⊕⊕⊖⊖

Lowa,b

12 participants in each regimen (10% with radiotherapy + hysterectomy vs 9% with radiotherapy) were lost to follow‐up by 5 years.

Progression‐free survival

Median follow‐up 9.6 years

HR 0.77

(0.54 to 1.10)

256

(1 RCT)

⊕⊕⊖⊖

Lowa,b

12 participants in each regimen (10% with radiotherapy + hysterectomy vs 9% with radiotherapy) were lost to follow‐up by 5 years.

Tumour‐free actuarial survival at 5 years

5‐year, tumour‐free actuarial survival for women with Stage IB was 80% in the preoperative radiotherapy + hysterectomy group and 89% in the radiotherapy group. In Stage IIA, these rates were 79% in the preoperative radiotherapy + hysterectomy group and 56% in the radiotherapy group.

118

(1 RCT)

⊕⊖⊖⊖

Very lowa,b,c

—

Quality of life

—

—

—

Not reported.

Severe/serious adverse events

1 trial stated that both treatment programmes were well tolerated and there were no differences between groups in adverse effects. There were 18/129 women with a grade 3 or 4 adverse effect in the radiotherapy + hysterectomy group and 19 cases in 18/121 women of severe adverse effects in the radiotherapy group.

In another trial, only 1/48 (2%) women with Stage IB disease experienced a severe complication (grade 3) in the radiotherapy + hysterectomy group (ureteral stricture) whereas 5/40 experienced severe complications in the radiotherapy group (including rectovaginal fistula, vesicovaginal fistula, ureteral stricture and pelvic infection) (P > 0.05). Similarly in women with Stage IIA disease, 5/14 (40%) women experienced a severe complication in the radiotherapy + hysterectomy group (including proctitis, rectal stricture, small bowel stricture and ureteral stricture) whereas only 1/16 women experienced a severe complication in the radiotherapy group (rectal stricture) (P > 0.05).

374

(2 RCTs)

⊕⊕⊖⊖

Lowa,b

Relative effect measures were not presented due to the crude combining of adverse events or sparse data, or both.

CI: confidence interval; HR: hazard ratio; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded one level due to sparse data leading to imprecision.
bDowngraded one level due to small number of trials and a lack of representation.
cDowngraded one level due to inadequate reporting of results.

Figuras y tablas -
Summary of findings 3. Hysterectomy (simple or radical) with radiotherapy versus radiotherapy alone
Ir a la tabla de la revisión
Summary of findings 4. Hysterectomy (simple or radical) with chemoradiotherapy versus chemoradiotherapy alone

Hysterectomy (simple or radical) with chemoradiotherapy versus chemoradiotherapy alone

Patient or population: women with locally advanced cervical cancer

Settings: outpatient

Intervention: chemoradiotherapy + hysterectomy (simple or radical)

Comparison: chemoradiotherapy alone

Outcomes

Relative effect

No of participants

Certainty of the evidence (GRADE)

Comments

Overall survival

Median follow‐up 3.8 years

Overall survival was inadequately reported and it was not possible to calculate a hazard ratio. Overall survival time in the chemoradiotherapy + hysterectomy group was 6–40 months, median survival time was 23 months, and 3‐year survival rate was 82.7%. Total survival time in the chemoradiotherapy group was 5–41 months, median survival time was 22.5 months and 3‐year survival rate was 81.8%. Trial authors reported differences between arms were not statistically significant (P = 0.56).

102
(1 RCT)

⊕⊝⊝⊝
Very lowa,b

—

Progression or event‐free survival

Median follow‐up 3.8 years

Progression‐free survival was inadequately reported in both trials and it was not possible to calculate a hazard ratio. In 1 trial, progression‐free survival time in the chemoradiotherapy + hysterectomy group was 3–40 months, median survival time was 23 months and 3‐year survival rate was 73.1%. The progression‐free survival time in the chemoradiotherapy alone group was 5–41 months, median survival time was 22 months and 3‐year survival rate was 64.8%. There was no significant difference between arms (P = 0.76).

Another trial included 61 women and compared chemoradiotherapy + simple or radical hysterectomy vs chemoradiotherapy alone. There was no difference in 3‐year event‐free (death) survival rate (86% in the chemoradiotherapy + hysterectomy group vs 97% in the chemoradiotherapy alone group; log rank P = 0.15).

163
(2 RCT)

⊕⊝⊝⊝
Very lowa,b

—

Quality of life

—

—

—

Not adequately reported.

Severe/serious adverse events

—

—

—

Not adequately reported.

RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded two levels due to sparse data leading to imprecision.
bDowngraded one level due to small number of trials and a lack of representation.

Figuras y tablas -
Summary of findings 4. Hysterectomy (simple or radical) with chemoradiotherapy versus chemoradiotherapy alone
Ir a la tabla de la revisión
Summary of findings 5. Hysterectomy (simple or radical) with chemoradiotherapy versus internal radiotherapy (brachytherapy) with chemoradiotherapy

Hysterectomy (simple or radical) with chemoradiotherapy versus internal radiotherapy (brachytherapy) with chemoradiotherapy

Patient or population: women with locally advanced cervical cancer

Settings: outpatient

Intervention: chemoradiotherapy + hysterectomy (simple or radical)

Comparison: chemoradiotherapy alone

Outcomes

Relative effect
(95% CI)

No of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Overall survival

Median follow‐up 3 years

HR 0.65 (95% CI 0.35 to 1.21)

211
(1 RCT)

⊕⊕⊝⊝
Lowa,b

—

Progression or event‐free survival

Median follow‐up 3 years

HR 0.70 (95% CI 0.31 to 1.34)

211
(1 RCT)

⊕⊕⊝⊝
Lowa,b

—

Quality of life

—

—

—

Not reported.

Severe late complications

There was no difference in the proportion of women with severe late complications in the brachytherapy and radical hysterectomy groups (P = 0.53). There were 4 cases of grade 3 or 4 proctitis in the brachytherapy group vs 2 cases in the radical hysterectomy group; 3 cases of severe cystitis in the brachytherapy group vs 0 in the radical hysterectomy group; 0 cases of grade 3 or 4 hydronephrosis in either group.

Of the 211 participants, chemoradiotherapy with cisplatin and gemcitabine appeared to be reasonably well tolerated, although nearly a third of women experienced severe neutropenia (most grade 3). Of the 86 women who received a radical hysterectomy, the number of intraoperative and early surgical complications appeared to be reasonably low, with bleeding (9/86) being the most common.

211
(1 RCT)

⊕⊕⊝⊝
Lowa,b

—

CI: confidence interval; RCT: randomised controlled trial.

GRADE Working Group grades of evidence
High certainty: further research is very unlikely to change our confidence in the estimate of effect.
Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low certainty: we are very uncertain about the estimate.

aDowngraded one level due to sparse data leading to imprecision.
bDowngraded one level due to small number of trials and a lack of representation.

Figuras y tablas -
Summary of findings 5. Hysterectomy (simple or radical) with chemoradiotherapy versus internal radiotherapy (brachytherapy) with chemoradiotherapy
Ir a la tabla de la revisión
Table 1. Comparison of 2009 and 2018 FIGO staging of cervical cancer

Stage I (2018): carcinoma strictly confined to the cervix (extension to the uterine corpus should be disregarded)

2009 FIGO stage: description

2018 FIGO stage: description

Comment

IA: invasive carcinoma diagnosed only by microscopy, with maximum depth of invasion </= 5 mm and largest extension </= 7 mm

IA: invasive carcinoma diagnosed only by microscopy, with maximum depth of invasion < 5 mm

– Lateral extent of the carcinoma is no longer considered in distinguishing between FIGO Stage IA and IB carcinomas

– If margins of loop are involved patient is allocated to Stage IB1

  • IA1: measured stromal invasion < 3 mm in depth and extension </= 7 mm

  • IA1: measured stromal invasion < 3 mm in depth

  • IA2: measured stromal invasion >/= 3 mm and < 5 mm in depth and extension </= 7 mm

  • IA2: measured stromal invasion >/= 3 mm and < 5 mm in depth

IB: clinically visible lesions limited to the cervix or preclinical cancers greater than Stage IA 

IB: invasive carcinoma with measured deepest invasion >/= 5 mm (greater than Stage IA), lesion limited to the cervix uteri

– See above

– LVSI must be commented upon, although does not affect FIGO stage

  • IB1: clinically visible lesion </= 4 cm in greatest dimension

IB1: invasive carcinoma >/= 5 mm depth of stromal invasion, and < 2 cm in greatest dimension

– New stage category

IB2: invasive carcinoma >/= 2 cm and < 4 cm in greatest dimension

– New stage category

IB2: invasive carcinoma > 4 cm in greatest dimension

IB3: invasive carcinoma >/= 4 cm in greatest dimension

– New stage category

Adapted from Singh 2019.
LVSI: lymphovascular space invasion.

Figuras y tablas -
Table 1. Comparison of 2009 and 2018 FIGO staging of cervical cancer
Ir a la tabla de la revisión
Comparison 1. Hysterectomy (radical) with neoadjuvant chemotherapy (NACT) versus chemoradiotherapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Overall survival Show forest plot

2

Hazard Ratio (IV, Random, 95% CI)

0.94 [0.76, 1.16]
Figuras y tablas -
Comparison 1. Hysterectomy (radical) with neoadjuvant chemotherapy (NACT) versus chemoradiotherapy alone
Ir a la tabla de la revisión
Comparison 2. Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Overall survival Show forest plot

3

Hazard Ratio (IV, Random, 95% CI)

0.71 [0.55, 0.93]

2.2 Disease‐ or progression‐free survival Show forest plot

3

Hazard Ratio (IV, Random, 95% CI)

0.75 [0.53, 1.05]
Figuras y tablas -
Comparison 2. Hysterectomy (simple or radical) with neoadjuvant chemotherapy (NACT) versus radiotherapy alone
Ir a la tabla de la revisión