2023年国际妇产科联盟子宫内膜癌分期改善预后分层，反映侵袭性组织学类型和p53异常的不良预后。
Improved Prognostic Stratification With 2023 International Federation of Gynecology and Obstetrics Staging in Endometrial Cancer Reflecting Poor Prognosis of Aggressive Histological Types and p53 Abnormality.
作者信息
Lee Miseon, Yoon Heesoo, Kim Ujae, Kang Jun, Han Yeon Bi, Lee Keun Ho, Lee Sung Jong, Hong Sook Hee, Suh Dong Hoon, Kim Kidong, No Jae Hong, Kim Yong Beom, Kim Hyojin, Lee Ahwon
机构信息
Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Lab Invest. 2025 Apr 29;105(9):104189. doi: 10.1016/j.labinv.2025.104189.
This study compares the distribution and prognostic impact of the 2009 and 2023 International Federation of Gynecology and Obstetrics (FIGO) staging systems for endometrial cancer and their impact on the 2022 European Society for Medical Oncology (ESMO) risk classification. Patients were restaged according to the 2009 FIGO staging system, the 2023 FIGO staging system, and the 2023 FIGO staging system with molecular classification. Risk groups were assigned according to the 2022 ESMO guidelines using each staging system. Among 679 patients, 139 (20.5%) experienced stage migration when transitioning from the 2009 FIGO staging system to the 2023 FIGO staging system with molecular classification, with 121 (17.8%) upstaged and 18 (2.7%) downstaged. Most changes were from FIGO stage I to stage II, primarily due to p53 abnormality, aggressive histological type, or extensive/substantial lymphovascular space invasion. Hazard ratios for overall survival, disease-free survival, and event-free survival increased with advancing stage groups in all systems, showing the greatest differences when the 2023 FIGO staging system with molecular classification was used. The newly introduced FIGO stages IC, IIC (both representing aggressive histological types), and IICmp53abn (associated with p53 abnormality) in the 2023 FIGO staging system were associated with worse outcomes, similar to FIGO stage III. The prognostic predictability of the 2022 ESMO risk group was minimally affected by the transition from the 2009 FIGO to the 2023 FIGO staging system, as the factors introduced in the new FIGO system were already incorporated into the 2022 ESMO risk classification. Only 17 (2.5%) patients experienced a change in their assigned risk group. The 2023 FIGO staging system showed improved prognostic stratification over the 2009 FIGO staging system, particularly by reflecting the poor prognosis of aggressive histological types and p53 abnormality.
本研究比较了2009年和2023年国际妇产科联盟（FIGO）子宫内膜癌分期系统的分布及预后影响，以及它们对2022年欧洲医学肿瘤学会（ESMO）风险分类的影响。根据2009年FIGO分期系统、2023年FIGO分期系统以及带有分子分类的2023年FIGO分期系统对患者进行重新分期。使用每种分期系统，根据2022年ESMO指南分配风险组。在679例患者中，从2009年FIGO分期系统过渡到带有分子分类的2023年FIGO分期系统时，139例（20.5%）出现分期迁移，其中121例（17.8%）分期上调，18例（2.7%）分期下调。大多数变化是从FIGO I期到II期，主要原因是p53异常、侵袭性组织学类型或广泛/大量淋巴管间隙浸润。在所有系统中，总生存、无病生存和无事件生存的风险比随分期组的进展而增加，使用带有分子分类的2023年FIGO分期系统时差异最大。2023年FIGO分期系统中新引入的FIGO IC期、IIC期（均代表侵袭性组织学类型）和IICmp53abn期（与p53异常相关）与较差的预后相关，类似于FIGO III期。从2009年FIGO分期系统过渡到2023年FIGO分期系统对2022年ESMO风险组的预后预测能力影响极小，因为新FIGO系统中引入的因素已纳入2022年ESMO风险分类中。只有17例（2.5%）患者的指定风险组发生了变化。2023年FIGO分期系统比2009年FIGO分期系统显示出更好的预后分层，特别是通过反映侵袭性组织学类型和p53异常的不良预后。
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