FIGO 2023 staging may result in overtreatment of early-stage endometrial cancer

The FIGO staging system for endometrial cancer was updated in 2023 to reflect the role of molecular classification, histology types, and tumor patterns in our understanding of endometrial cancer. Treatment based on published research cannot be easily abstracted for patients with early endometrial cancer who are upstaged based on FIGO 2023 staging. This upstaging may result in increased treatment including additional toxicity with unclear impact on cancer outcomes. Neither the NCCN guidelines nor the literature on which treatment is based address the best treatment for patients who are upstaged. Our objective was to quantify the potential impact of the upstaging on treatment recommendations for patients with disease confined to the uterus and cervix.

The population of patients who underwent upstaging was calculated based on the total number of expected patients with endometrial cancer per the American Cancer Society 2024 estimate and stage migration for stage I and II disease as published by Schwameis et al. [1]. Phase III trials were reviewed along with the NCCN guidelines to assign treatment options for each stage. Differences in treatment recommendations were identified, and the annual population impact was calculated. Toxicity impact was calculated using percentages from relevant PORTEC and GOG studies.

Upstaging has the potential to result in additional chemotherapy and radiation. Gynecologic Oncologists need to be cautious in applying literature-based treatment recommendations based on FIGO 2023 staging. Further research is needed to better define guidelines for treatment of these new stage subsets to minimize toxicity and maximize treatment efficacy.