Palmieri Emilia, Mariani Andrea, Coleman Robert, Croce Sabrina, Hui Pei, Lax Sigurd, Matias-Guiu Xavier, Mutch David, Scambia Giovanni, Sehouli Jalid, Slomovitz Brian M, Stolnicu Simona, Fotopoulou Christina, Concin Nicole
Mayo Clinic, Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN, USA; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Roma, Italy.
Mayo Clinic, Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN, USA.
Int J Gynecol Cancer. 2025 Aug;35(8):101823. doi: 10.1016/j.ijgc.2025.101823. Epub 2025 Apr 11.
In August 2023, the International Federation of Gynecology and Obstetrics introduced an updated staging system for endometrial cancer that integrates histopathologic and molecular characteristics (optional) of the tumor alongside with anatomic extent of the disease. This innovative approach aims to improve the prognostication of the system and the identification of treatment-relevant patient populations by more accurately stratifying patients based on tumor biology, representing a significant advancement toward personalized medicine. However, its implementation poses challenges, including the heterogeneous availability of molecular testing worldwide, and the need for further standardization and prospective validation of some of the newly introduced histopathological parameters. To address these innovations and related controversies, a meeting of physicians, including gynecologic oncologists and pathologists, was held. This article summarizes the reflections that emerged from this meeting, focusing on key elements such as the integration of histopathologic features (eg, "high-grade, aggressive histologic types," "substantial lymphovascular space invasion"), molecular classification, and the implications for global reproducibility and applicability. It also addresses the basic approach toward staging: should it offer integrated, patient-relevant information to enable accurate prognostication and inform treatment decisions or should a staging system simply provide a common language to communicate disease extent? The meeting provided an opportunity for a group of physicians to share considerations on this evolving topic. Our article highlights focal points of change in the new staging system and identifies key areas for future research, advocating for collaborative efforts to generate more robust evidence on some variables introduced in the staging system through prospective studies. By addressing these challenges, we aim to improve the applicability and effectiveness of the new International Federation of Gynecology and Obstetrics staging system in real-world scenarios and identify elements that may require further refinement, ultimately advancing precision medicine in endometrial cancer care.
2023年8月，国际妇产科联合会推出了一种子宫内膜癌的更新分期系统，该系统将肿瘤的组织病理学和分子特征（可选）与疾病的解剖范围相结合。这种创新方法旨在通过更准确地根据肿瘤生物学对患者进行分层，改善该系统的预后评估以及识别与治疗相关的患者群体，这代表着在个性化医疗方面取得了重大进展。然而，其实施带来了挑战，包括全球分子检测的可用性参差不齐，以及一些新引入的组织病理学参数需要进一步标准化和前瞻性验证。为了解决这些创新和相关争议，召开了一次由包括妇科肿瘤学家和病理学家在内的医生参加的会议。本文总结了此次会议产生的思考，重点关注组织病理学特征（如“高级别、侵袭性组织学类型”“大量淋巴管间隙浸润”）的整合、分子分类以及对全球可重复性和适用性的影响等关键要素。它还探讨了分期的基本方法：它应该提供与患者相关的综合信息以实现准确的预后评估并为治疗决策提供依据，还是分期系统仅仅提供一种用于传达疾病范围的通用语言？这次会议为一群医生提供了一个分享对这个不断发展的话题的思考的机会。我们的文章突出了新分期系统中的变化焦点，并确定了未来研究的关键领域，倡导通过前瞻性研究进行合作努力，以生成关于分期系统中引入的一些变量的更有力证据。通过应对这些挑战，我们旨在提高新的国际妇产科联合会分期系统在实际场景中的适用性和有效性，并识别可能需要进一步完善的要素，最终推动子宫内膜癌护理中的精准医疗发展。
