目的:子宫内膜癌(EC)的国际妇产科联合会(FIGO)2023分期系统已发布,并结合了组织学,淋巴管间隙浸润,和分子分类在一起。我们的目的是进一步探讨2023FIGO分期系统在中国的临床实用性和预后意义。
方法:对2018年12月至2023年12月在复旦大学上海癌症中心接受标准手术并使用多基因下一代测序(NGS)小组进行基因检测的患者进行了回顾性分析。上海,中国。分析所有患者的基因组和临床资料,阶段由2009年和2023年的FIGO分期系统确定。使用Kaplan-Meier估计和Cox比例风险模型进行生存分析。
结果:共547名患者纳入研究。在FIGO2023分期系统进行重播后,147/547(26.9%)例患者发生了分期变化.在FIGO2009早期阶段(I-II期)的患者中,由于POLEmut和p53abn的分子分类,63例重新排列为IAmPOLEmut,53例重新排列为IICmp53abn。共有345例处于第一阶段,第二阶段107例,III期69例,根据FIGO2023分期标准,IV期26例。对于第一阶段的疾病,2009年和2023年的FIGO分期系统的3年PFS率为92.7%和95.3%,分别。2023年FIGO第二阶段的3年PFS低于2009年的FIGO(3年PFS:85.0%对90.9%),尤其是在亚组IIC和IICmp53abn中。2009年第IIIA期的3例(12%)转移到第IA3期,第2023期,3年PFS率为90.9%与100%,分别。在NGS分析中,在PTEN和PIK3CA中观察到最普遍的基因改变.
结论:与FIGO2009相比,FIGO2023分期系统被证明是EC患者生存率的良好预测指标。在早期疾病中观察到主要的阶段转移。不同亚型的不同基因改变可能有助于探索更准确的靶向治疗。
OBJECTIVE: The International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system for endometrial cancer (EC) was released with incorporating histology, lympho-vascular space invasion, and molecular classification together. Our objective is to further explore the clinical utility and prognostic significance of the 2023 FIGO staging system in
China.
METHODS: A retrospective analysis was conducted for patients who received standard surgeries and underwent genetic testing using multigene next-generation sequencing (NGS) panels between December 2018 and December 2023 at Fudan University Shanghai Cancer Center, Shanghai,
China. The genomic and clinical data of all patients were analyzed, and stages were determined by both the 2009 and 2023 FIGO staging systems. Kaplan-Meier estimators and Cox proportional hazards models were used for survival analysis.
RESULTS: A total of 547 patients were enrolled in the study. After the restaged by the FIGO 2023 staging system, stage shifts occurred in 147/547 (26.9%) patients. In patients with early stages in FIGO 2009 (stage I-II), 63 cases were rearranged to IAmPOLEmut and 53 cases to IICmp53abn due to the molecular classification of POLEmut and p53abn. Altogether 345 cases were in stage I, 107 cases in stage II, 69 cases in stage III, and 26 cases in stage IV according to the FIGO 2023 staging criteria. For stage I diseases, the 3-year PFS rate was 92.7% and 95.3% in 2009 and 2023 FIGO staging systems, respectively. The 3-year PFS of stage II in 2023 FIGO was lower than that of FIGO 2009 (3-year PFS: 85.0% versus 90.9%), especially in substage IIC and IICmp53abn. Three cases (12%) of stage IIIA in FIGO 2009 were shifted to stage IA3 FIGO 2023, with 3-year PFS rates of 90.9% versus 100%, respectively. In NGS analysis, the most prevalent gene alterations were observed in PTEN and PIK3CA.
CONCLUSIONS: The FIGO 2023 staging system was proved to be a good predictor of survival for EC patients with enhanced precision compared to FIGO 2009. Predominant stage shifts were observed in early-stage diseases. Distinct gene alterations of different subtypes may help to explore more accurate target therapies.