Uterine Carcinosarcoma: Adaptation to New FIGO 2023 Staging System Through Clinical Profile and Oncologic Outcomes

Objective: We aimed to analyze the impact of stage shifts on disease-free survival and overall survival in patients with uterine carcinosarcoma stratified based on FIGO 2009 and 2023 staging systems. Materials and Methods: A total of forty-five patients diagnosed with uterine carcinosarcoma between 2010 and 2024 were included in the study. Patients were classified and analyzed according to both the 2009 and the revised 2023 FIGO staging systems to evaluate the impact of the updated staging criteria on oncologic outcomes. The median disease-free (DFS) and overall survival (OS) rates were calculated and compared when stage shifts occurred. Results: A total of 17 upstage shifts (37.7%) occurred between the 2009 and 2023 FIGO staging system. All patients with upstage shifts were stage I patients categorized according to the FIGO 2009 classification. Restaging from the FIGO 2009 to the FIGO 2023 criteria resulted in a reduction in the number of stage I cases and an increase in the number of stage II cases. The two main factors leading to upstage were serous histology and LVSI positivity. The 5-year DFS and OS rates for stage I disease were 80% and 75%, respectively, according to the 2009 FIGO staging system, whereas the 2023 FIGO staging system demonstrated significantly higher rates of 100% for both DFS and OS. In stage II patients, the 5-year DFS and OS rates were 33.5% and 33.7%, respectively, according to the 2009 FIGO staging system, while the 2023 FIGO staging system demonstrated higher rates of 58.8% for DFS and 65% for OS. Conclusions: The revised FIGO 2023 staging system has better performance in predicting disease prognosis than the previous version.