1. Uptodate uses also a slightly different

1. The risk group classification proposed by ESMO is an updated classification scheme based mainly on the results from the trials evaluating the benefit of adjuvant RT in intermediate risk patients (PORTEC-1, GOG99, ASTEC/EN5) and a subsequent meta-analysis. These results defined the strongest risk factors and led ESMO panel to propose the risk classification and adjuvant treatment algorithm. There are other risk factors included in the treatment recommendations by other institutes which are not taken into account by ESMO. As an example tumor size >2 cm is considered by NCCN a prognostic factor that can influence adjuvant RT even in the low risk group (IA, Gr 1-2) based on observational studies that showed >15% prevalence of lymph nodes metastases in this particular group. Mayo clinic uses the 2 cm cut off to guide decision for lymphadenectomy in early stages which is also supported by Uptodate. Uptodate uses also a slightly different risk group taxonomy as it includes age among other prognostic factors to differentiate low intermediate from high intermediate risk group based on the risk group definitions used in PORTEC and GOG trials. Stage II with occult cervical involvement is not considered high risk but rather intermediate by Uptodate as it is not clear whether cervical involvement alone offers a higher risk of recurrence compared to stage I. This comes from the fact that stage II is associated in most cases with Gr 3 and deep myometrial invasion so it is not clear whether cervical involvement is independent prognostic factor.


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