Analysing the clinical outcomes between FIGO 2009 and 2023 staging for endometrial cancer-a single institution retrospective study.

Abstract

The latest International Federation of Gynaecology and Obstetrics (FIGO) staging for endometrial cancer incorporated molecular profiles and histopathological factors into the basic staging framework. This study was done to determine its implications when applied in real-world clinical practice. The main objectives were to analyse the stage shifts and determine the stage-wise 3-year overall survival (OS) and disease-free survival (DFS) between the two staging systems. It was a single-institution retrospective study that included all Endometrial cancer patients who underwent surgery between January 2015 and June 2021. Cases that underwent primary or incomplete surgery elsewhere and cases with histological types of cancer not included in FIGO 2023 staging were excluded from the study. All patients were staged according to FIGO 2009 and 2023 staging for endometrial cancer. This study found most stage shifts among stage I cases; based on aggressive histology, 33.8% (n = 65/192) of cases in stage IA and IB upstaged to stage IIC (2023). Meanwhile, among the advanced stages, most were downstaged, i.e., from stage IIIA to stage IA3 0.6% (n = 1/15), from stage IVB to stage IIIB2 (2023), i.e., 32% (n = 8/25). This study failed to show any significant differences in the stage-wise 3-year OS rate and DFS rate between the two staging systems. The present study provided preliminary data on the latest FIGO endometrial staging system. Due to the addition of subgroups based on prognostic factors, most upstages occurred in the early stages, while downshifts occurred in the advanced stages. There was no clinical difference in the 3-year OS and DFS rates.