Abstract：
OBJECTIVE: To assess the stage distribution and stage-related disease-specific survival rates for endometrial cancer using the FIGO (the International Federation of Gynecology & Obstetrics) 2009 and 2023 staging systems. Further, we sought to evaluate the prognostic utility of additional covariates beyond the FIGO 2023 stage.
METHODS: Endometrial carcinomas were molecularly classified by the Proactive Molecular Risk Classifier for Endometrial Cancer and staged according to FIGO 2009 and 2023 criteria. Disease-specific survival was calculated as the time from surgery to death from endometrial cancer.
RESULTS: Data from 604 patients were analyzed. Median follow-up time was 81 months. A total of 118 stage shifts (19.5%) occurred between the FIGO 2009 and FIGO 2023 systems, with upshifts accounting for 107 (90.7%) of these changes. Within the FIGO 2023 system, molecular classification resulted in restaging of 69 patients (11.4%). Shifts that could alter adjuvant therapy decisions were identified in 23 patients (3.8%). The FIGO 2023 system effectively categorized endometrial cancers into prognostic subgroups. The FIGO 2023 stage, tumor size, positive peritoneal cytology, and mismatch repair deficiency were associated with disease-specific survival in a multivariable analysis, whereas age and adjuvant therapy were not.
CONCLUSIONS: The FIGO 2023 staging system for endometrial cancer appears highly prognostic. Prognostic assessment of the patients can be further enhanced by readily accessible covariates. A stage shift between the FIGO 2009 and 2023 systems occurs in about one-fifth of patients. The implementation of molecular classification within the FIGO 2023 system bears implications for decisions regarding adjuvant therapy.
METHODS: Endometrial carcinomas were molecularly classified by the Proactive Molecular Risk Classifier for Endometrial Cancer and staged according to FIGO 2009 and 2023 criteria. Disease-specific survival was calculated as the time from surgery to death from endometrial cancer.
RESULTS: Data from 604 patients were analyzed. Median follow-up time was 81 months. A total of 118 stage shifts (19.5%) occurred between the FIGO 2009 and FIGO 2023 systems, with upshifts accounting for 107 (90.7%) of these changes. Within the FIGO 2023 system, molecular classification resulted in restaging of 69 patients (11.4%). Shifts that could alter adjuvant therapy decisions were identified in 23 patients (3.8%). The FIGO 2023 system effectively categorized endometrial cancers into prognostic subgroups. The FIGO 2023 stage, tumor size, positive peritoneal cytology, and mismatch repair deficiency were associated with disease-specific survival in a multivariable analysis, whereas age and adjuvant therapy were not.
CONCLUSIONS: The FIGO 2023 staging system for endometrial cancer appears highly prognostic. Prognostic assessment of the patients can be further enhanced by readily accessible covariates. A stage shift between the FIGO 2009 and 2023 systems occurs in about one-fifth of patients. The implementation of molecular classification within the FIGO 2023 system bears implications for decisions regarding adjuvant therapy.
摘要：
目的：使用FIGO（国际妇产科联合会）2009年和2023年分期系统评估子宫内膜癌的分期分布和与分期相关的疾病特异性生存率。Further,我们试图评估FIGO2023期以外的其他协变量的预后效用.
方法：子宫内膜癌根据子宫内膜癌的前反应分子风险分类法进行分子分类，并根据FIGO2009和2023标准进行分期。疾病特异性生存期计算为从手术到子宫内膜癌死亡的时间。
结果：分析了来自604例患者的数据。中位随访时间为81个月。FIGO2009和FIGO2023系统之间总共发生了118个阶段转换（19.5％），升档占这些变化的107(90.7%)。在FIGO2023系统中，分子分类导致69例患者(11.4%)重新分组.在23例患者中发现了可能改变辅助治疗决策的转变（3.8％）。FIGO2023系统有效地将子宫内膜癌分类为预后亚组。FIGO2023阶段，肿瘤大小,腹膜细胞学检查阳性，在多变量分析中，错配修复缺陷与疾病特异性生存率相关，而年龄和辅助治疗则没有。
结论：子宫内膜癌的FIGO2023分期系统显示出高度预后。患者的预后评估可以通过容易获得的协变量进一步增强。FIGO2009和2023系统之间的阶段转换发生在大约五分之一的患者中。在FIGO2023系统中实施分子分类对有关辅助治疗的决策具有重要意义。
方法：子宫内膜癌根据子宫内膜癌的前反应分子风险分类法进行分子分类，并根据FIGO2009和2023标准进行分期。疾病特异性生存期计算为从手术到子宫内膜癌死亡的时间。
结果：分析了来自604例患者的数据。中位随访时间为81个月。FIGO2009和FIGO2023系统之间总共发生了118个阶段转换（19.5％），升档占这些变化的107(90.7%)。在FIGO2023系统中，分子分类导致69例患者(11.4%)重新分组.在23例患者中发现了可能改变辅助治疗决策的转变（3.8％）。FIGO2023系统有效地将子宫内膜癌分类为预后亚组。FIGO2023阶段，肿瘤大小,腹膜细胞学检查阳性，在多变量分析中，错配修复缺陷与疾病特异性生存率相关，而年龄和辅助治疗则没有。
结论：子宫内膜癌的FIGO2023分期系统显示出高度预后。患者的预后评估可以通过容易获得的协变量进一步增强。FIGO2009和2023系统之间的阶段转换发生在大约五分之一的患者中。在FIGO2023系统中实施分子分类对有关辅助治疗的决策具有重要意义。
