Early-Stage Risk Redistribution After Clinicopathologic Restaging From FIGO 2009 to FIGO 2023 in Endometrial Cancer
Yue Gao1, Qi Chen2, Huali Wang1
1Department of Gynecology, Dalian Women and Children's Medical Center (Group), Dalian, Liaoning, China.
Aim:
To examine how clinicopathologic reassignment under FIGO 2023 alters risk grouping and five-year survival patterns among patients staged as early disease by FIGO 2009 when molecular classifiers are unavailable.
Methods:
The cohort comprised 351 patients treated with primary surgery from June 2010 through May 2019. All cases contributed to the restaging analysis; one case with contradictory survival coding was omitted from time-to-event analyses, leaving 350 evaluable patients. Five-year survival was described with Kaplan-Meier estimates.
Results:
Stage migration occurred in 81 of 351 patients (23.1%): 75 (21.4%) were upstaged and 6 (1.7%) were downstaged; 222 (63.2%) underwent substage refinement. In the 295-patient early-stage cohort, FIGO 2009 showed no stage I-to-II survival gradient (96.7% vs. 100.0%; p = 0.440), whereas reassignment under FIGO 2023 separated stage I from stage II (99.0% vs. 91.9%; p = 0.001). Among 277 FIGO 2009 stage I patients, 74 were upstaged; 8 of 9 deaths occurred in the upstaged group (five-year overall survival, 89.0% vs. 99.5%; p < 0.001). Among the 75 upstaged stage I cases, 66 (88.0%) followed FIGO 2023 IC/IIC pathways defined by aggressive histology, whereas all 9 patients reassigned to IIB had substantial LVSI.
Conclusions:
Clinicopathologic FIGO 2023 restaging redistributed adverse outcomes from former stage I into stage II and showed greater five-year overall survival separation. The findings apply to the clinicopathologic framework and do not constitute validation of molecularly integrated staging.