Abstract：
Embracing the complex and diverse nature of the heterogenous group of malignancies that are included under the umbrella of \"endometrial cancer\" (EC) to better align prognosis with treatment recommendations, requires a more comprehensive staging system. Our goal at the development of the new FIGO staging was to provide 1) high accuracy in the predictive prognosis for a patient with EC, which is the genuine purpose of a staging system, and 2) identification of distinct treatment relevant subgroups. Since the publication of the 2009 staging system by the International Federation of Gynecology and Obstetrics (FIGO) 14 years ago (1, 2), our understanding of the biology and natural history of EC has undergone a radical transformation. The TGCA results in 2013 (3), and the many validation reports published since then (4-9), have taught us that \"EC\" is composed of at least four distinct molecularly defined diseases. Strong histopathologic markers reflecting tumor biology such as lymph vascular space invasion (LVSI) were identified. Importantly, anatomical borders were shown to lose their prognostic relevance for EC patients in the presence of dominant tumor biology-markers such as molecular subtypes/LVSI (10, 11). This emphasizes the integration of these novel markers into a prognostic staging system that aims to be relevant to patients. The 2023 FIGO staging system for EC harmonizes and integrates old and new knowledge on anatomic, histopathologic, and molecular features (12). It requires a change in our perception of a staging system, from a traditional purely anatomical borders-based system to an integrated staging system integrating anatomical borders and tumor biology as pivotal prognostic factors for EC patients while providing important information for treatment decision making. Therefore, the 2023 FIGO staging system demonstrates the logical next step in the evolution of the revolution in a patient-centric staging approach. Below, we elucidate the rationale for the FIGO 2023 endometrial cancer staging system.
摘要：
背景：纳入“子宫内膜癌”（EC）范围内的异质性恶性肿瘤的复杂性和多样性，以使预后与治疗建议更好地保持一致，需要更全面的暂存系统。我们开发新的FIGO分期的目标是为EC患者提供1）高准确性的预测预后，这是分期系统的真正目的，和2)不同治疗相关亚组的鉴定。自14年前（1，2）国际妇产科联合会（FIGO）发布2009年分期系统以来，我们对EC的生物学和自然史的理解发生了根本性的转变。TGCA结果在2013年（3），以及此后发布的许多验证报告(4-9)，告诉我们，“EC”至少由四种不同的分子定义的疾病组成。鉴定了反映肿瘤生物学的强组织病理学标志物,例如淋巴管间隙侵入(LVSI)。重要的是,在存在显性肿瘤生物学标志物如分子亚型/LVSI的情况下,解剖边界对EC患者的预后失去相关性(10,11).这强调了将这些新标记物整合到旨在与患者相关的预后分期系统中。用于EC的2023FIGO分期系统协调并整合了有关解剖的新旧知识，组织病理学,和分子特征（12）。这需要我们改变对分期系统的看法，从传统的纯粹基于解剖边界的系统到整合解剖边界和肿瘤生物学的综合分期系统，将其作为EC患者的关键预后因素，同时为治疗决策提供重要信息。因此,2023年FIGO分期系统展示了以患者为中心的分期方法革命演变的合乎逻辑的下一步.下面,我们阐明了FIGO2023子宫内膜癌分期系统的基本原理.
