Department of Gynecologic Oncology, Tata Memorial Centre, Mumbai, India.
Department of Medical Oncology, Tata Memorial Centre, Mumbai, India.
Int J Gynaecol Obstet. 2019 May;145(2):245-252. doi: 10.1002/ijgo.12789. Epub 2019 Mar 6.
Since the last update of the International Federation of Gynecology and Obstetrics (FIGO) staging for corpus uteri cancer in 2009, a number of new insights into pathology, molecular genetics, and prognostic factors that justify a revision have been made. We recommend incorporation of histotype and grade along with depth of myometrial invasion to define stage I endometrial cancer, a change from 3-tier grading to binary grading, and inclusion of lymph node status (negative vs not removed) in the definition of stage I disease. Elimination of cervical involvement to define stage II and inclusion of positive peritoneal cytology to upstage otherwise stage I cancers to stage IIA is also recommended. Extrauterine pelvic involvement should be classified as stage IIB disease, and stage III should be reclassified based exclusively on retroperitoneal pelvic and/or para-aortic lymph node involvement. If feasible, molecular staging by immunohistochemistry (mismatch repair proteins and p53) as well as POLE exonuclease sequencing may be carried out in order to assign one of the four categories from The Cancer Genome Atlas.
自 2009 年国际妇产科联合会（FIGO）对子宫体癌分期的最后一次更新以来，病理学、分子遗传学和预后因素方面的许多新见解证明有必要进行修订。我们建议将组织类型和分级与肌层浸润深度结合起来定义 I 期子宫内膜癌，将 3 级分级改为 2 级分级，并将淋巴结状态（阴性与未切除）纳入 I 期疾病的定义。为了定义 II 期，建议消除宫颈受累，并将阳性腹膜细胞学检查用于将原本为 I 期的癌症升级为 IIA 期。子宫外盆腔受累应归类为 IIB 期疾病，III 期应仅根据腹膜后盆腔和/或主动脉旁淋巴结受累进行重新分类。如果可行，可通过免疫组织化学（错配修复蛋白和 p53）进行分子分期，以及 POLE 外切酶测序，以便从癌症基因组图谱中分配四个类别之一。
