Improved Prognostic Stratification with the FIGO 2023 Staging System in Endometrial Cancer: Real-World Validation in
Jun-Hyeong Seo1, Soo-Min Kim2, Yoo-Young Lee1
1Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Background/Objectives:
To assess the impact of the 2023 FIGO staging revision on stage distribution, survival outcomes, and prognostic performance in endometrial cancer compared to the 2009 system.
Methods:
This retrospective cohort study analyzed 2969 patients with FIGO 2009 stage I-III endometrial cancer diagnosed at Samsung Medical Center (1994-2023). Patients were reclassified per the 2023 FIGO system. Stage migration, progression-free survival (PFS), and overall survival (OS) were evaluated. Prognostic performance was compared using the Akaike information criterion (AIC), Bayesian information criterion (BIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC).
Results:
Stage migration occurred in 20.2% of patients, with 98.3% involving upstaging from FIGO 2009 stage I, largely due to the inclusion of aggressive histology, p53 abnormality, and substantial lymphovascular space invasion (LVSI). The proportion of stage I tumors decreased from 81.5% to 65.2%, while stage II increased to 21.9%, including 14.8% newly classified as stage IIC. Patients remaining in stage I showed favorable outcomes (5-year PFS: 95.3%, OS: 98.5%), whereas those upstaged-especially to stage IIC-had significantly worse outcomes (5-year PFS: 76.5%, OS: 83.1%). Tumors with p53 abnormalities had poorer survival (PFS: 70.8%, OS: 76.6%). The 2023 FIGO system outperformed the 2009 system in prognostic discrimination across all metrics.
Conclusions:
The FIGO 2023 staging revision improves prognostic accuracy in endometrial cancer by integrating histopathologic and molecular risk factors. These refinements enhance risk stratification and may support more individualized treatment strategies.
