Comparative prognostic performance of International Federation of Gynecology and Obstetrics 2023 staging system and
Jin Hwa Hong1, Sohyeon Jeong2, Yung Taek Ouh3
1Department of Obstetrics and Gynecology, 1Korea University Guro Hospital, Seoul, Korea. jhhong93@korea.ac.kr.
Objective:
To compare the prognostic performance of the International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system (FIGO 2023) and the 2025 European Society of Gynaecological Oncology (ESGO), European Society for Radiotherapy and Oncology, and European Society of Pathology (ESGO 2025) risk classification in endometrial cancer (EC).
Methods:
We retrospectively analyzed 296 patients who underwent primary surgical treatment for EC at a single tertiary institution. All cases were reclassified according to FIGO 2023 and ESGO 2025 using clinicopathological and molecular data. Recurrence-free survival (RFS) and disease-specific survival (DSS) were analyzed using the Kaplan-Meier method. Prognostic performance was assessed using the Akaike information criterion (AIC) and Harrell's concordance index (C-index) with bootstrap-derived 95% confidence intervals (CIs).
Results:
Kaplan-Meier analysis demonstrated significant differences in RFS and DSS according to both ESGO 2025 and FIGO 2023 (log-rank p<0.001). For recurrence prediction, ESGO 2025 showed better model fit than FIGO 2023, with a lower AIC value (410.849 vs. 428.644), and demonstrated a numerically higher C-index (0.8657; 95% CI, 0.8266-0.9114 vs. 0.8519; 95% CI, 0.8110-0.9005). In contrast, for disease-specific mortality prediction, FIGO 2023 showed better model fit than ESGO 2025, with a lower AIC value (143.758 vs. 148.109), and demonstrated a numerically higher C-index (0.9360; 95% CI, 0.9028-0.9769 vs. 0.9063; 95% CI, 0.8624-0.9628).
Conclusion:
ESGO 2025 and FIGO 2023 demonstrated distinct prognostic characteristics according to the clinical endpoint, suggesting complementary roles for molecularly integrated risk stratification and anatomical staging in the management of EC.