Prognostic performance of FIGO 2023 endometrial carcinoma staging: a comparison to FIGO 2009 staging in the setting of known and unknown molecular classification

IF 3.9 2区医学 Q2 CELL BIOLOGY

Histopathology Pub Date : 2024-08-29 DOI:10.1111/his.15302

Diane Libert, Phoebe M Hammer, Caressa Hui, Elizabeth A Kidd, Ann K Folkins, Teri Longacre, Eric J Yang, Vivek Charu, Brooke E Howitt

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Abstract

Aims

The 2023 FIGO staging criteria for endometrial cancer (EC) introduced marked changes from the 2009 version. The full implication of these changes for patient diagnosis and treatment is unknown. We evaluate the differences in staging and prognostication between the two systems, with and without inclusion of molecular classification.

Methods and results

We assigned (1) FIGO 2009, (2) 2023 molecular-agnostic and (3) 2023 molecular-informed stages to 404 fully staged and molecularly classified patients with EC. Disease-specific and progression/relapse-free survival were analysed via the Kaplan–Meier method and compared with log-rank testing; 118 of 252 (47%) FIGO 2009 stage I patients were upstaged based on histopathological findings alone. Stage I/II subgroup survival distribution analysis showed a worse prognosis in FIGO 2023 IIB and IIC patients. In the molecular-informed FIGO 2023 system, three of 15 (20%) POLE-mutated stage I/II cases were downstaged from FIGO 2009 and eight (53%) were downstaged from molecular-agnostic FIGO 2023. Fifty-one of 60 (85%) p53-abnormal tumours were upstaged from the FIGO 2009, whereas 13 of 60 (22%) were upstaged from the 2023 molecular-agnostic stage. Molecular classification improved prognostic stratification for both 2009 and 2023 FIGO systems.

Conclusions

Downstaging based on POLE mutation more accurately represents patient outcomes. However, in the absence of known POLE status, applying molecular-agnostic FIGO 2023 criteria for stage I/II disease should be conducted with caution. For aggressive histotypes, additionally reporting FIGO 2009 stage should be considered. Upstaging based on substantial lymphovascular space invasion, aggressive histotype with any myometrial invasion and abnormal p53 improves prognostic discernment. Further subdivisions within stage I/II provide minimal additional prognostic information.

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FIGO 2023子宫内膜癌分期的预后效果：在已知和未知分子分类情况下与FIGO 2009分期的比较。

目的：2023 年 FIGO 子宫内膜癌（EC）分期标准与 2009 年版本相比发生了显著变化。这些变化对患者诊断和治疗的全面影响尚不清楚。我们评估了这两个系统在纳入和不纳入分子分类时在分期和预后方面的差异：我们对 404 名完全分期和分子分类的欧共体患者进行了(1) FIGO 2009、(2) 2023 分子诊断和(3) 2023 分子信息分期。通过 Kaplan-Meier 方法分析了疾病特异性生存期和无进展/无复发生存期，并通过对数秩检验进行了比较；在 252 例 FIGO 2009 I 期患者中，有 118 例（47%）仅根据组织病理学结果进行了分期。I/II 期亚组生存分布分析显示，FIGO 2023 IIB 和 IIC 期患者的预后较差。在分子信息FIGO 2023系统中，15例POLE突变I/II期病例中有3例（20%）从FIGO 2009中降级，8例（53%）从分子诊断FIGO 2023中降级。在 60 例 p53 异常肿瘤中，有 51 例（85%）的分期高于 FIGO 2009 分期，而在 60 例中，有 13 例（22%）的分期高于 2023 年分子诊断分期。分子分类改善了2009年和2023年FIGO系统的预后分层：结论：基于POLE突变的降期更准确地反映了患者的预后。然而，在不知道 POLE 状态的情况下，应用分子诊断 FIGO 2023 标准对 I/II 期疾病进行分期应慎重。对于侵袭性组织型，应考虑额外报告 FIGO 2009 分期。根据淋巴管间隙的实质性侵犯、侵袭性组织型、子宫肌层侵犯和 p53 异常进行分期可提高预后鉴别力。I/II 期的进一步细分只能提供极少的额外预后信息。

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来源期刊

Histopathology 医学-病理学

CiteScore

10.20

自引率

4.70%

发文量

239

审稿时长

1 months

期刊介绍： Histopathology is an international journal intended to be of practical value to surgical and diagnostic histopathologists, and to investigators of human disease who employ histopathological methods. Our primary purpose is to publish advances in pathology, in particular those applicable to clinical practice and contributing to the better understanding of human disease.