Uterine cancer restaging according to the updated 2023 FIGO Guidelines does not uniformly affect prognosis: An institutional retrospective cohort study

Efforts have been made to better risk stratify patients given the rise in incidence of endometrial cancer (EC). The 2023 FIGO staging now incorporates histologic subtype and molecular classification into determination of EC stage. We sought to elucidate if the new staging system demonstrated prognos...

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Bibliographic Details
Published in:	Gynecologic oncology Vol. 189; pp. 41 - 48
Main Authors:	Senguttuvan, R.N., Lugo-Santiago, N., Nakamura, B., Song, M., Han, E., Ruel, N., Cook, D., Robinson, K., Kohut, A., Cohen, J.G.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-10-2024
Subjects:	Adult Aged Aged, 80 and over Cohort Studies Endometrial cancer Endometrial Neoplasms - genetics Endometrial Neoplasms - mortality Endometrial Neoplasms - pathology Endometrial Neoplasms - therapy Female FIGO 2023 Humans Kaplan-Meier Estimate Middle Aged Molecular classification Neoplasm Staging Practice Guidelines as Topic Prognosis Progression-Free Survival Retrospective Studies Uterine Neoplasms - genetics Uterine Neoplasms - mortality Uterine Neoplasms - pathology Uterine Neoplasms - therapy Molecular classification Endometrial cancer FIGO 2023
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Summary:	Efforts have been made to better risk stratify patients given the rise in incidence of endometrial cancer (EC). The 2023 FIGO staging now incorporates histologic subtype and molecular classification into determination of EC stage. We sought to elucidate if the new staging system demonstrated prognostic differences compared to the 2009 staging system. A retrospective chart review was performed on women treated for EC at our institution from September 2013 to May 2023 and combined with the publicly available TCGA Nature 2013 dataset. Detailed clinical information was captured. Patients were restaged according to the 2023 guidelines. Survival estimates were obtained using Kaplan-Meier method, and the log-rank test was used to compare survival curves for progression-free survival (PFS). 919 patients were included in our analysis. The datasets were comparable regarding histologic grade, stage, and age at diagnosis. 175 (31.5%) of patients in the institution dataset and 115 (31.6%) patients in the TCGA dataset experienced a stage change. Most patients whose stage changed were upstaged (275/290; 94.8%). 3-year PFS estimates for stage IA patients with no stage change versus those upstaged were 92.3% (95% CI: 87.2, 95.4) v. 72.0% (95% CI: 68.4, 84.9), p = 0.002. No significant differences in survival difference were seen in other stage subsets. Modest survival differences exist in patients with EC originally staged as IA who underwent upstaging. No significant survival difference is observed in patients who are restaged to stage II or III subsets. Improved risk stratification is needed in assessing prognosis and adjuvant therapy for patients with endometrial cancer. •The 2023 FIGO endometrial cancer staging guidelines introduce new complexity and granularity to clinicians.•A modest survival difference is noted amongst FIGO 2009 stage IA patients who are restaged by the FIGO 2023 guidelines.•In this dataset, no prognostic difference is noted amongst patients with stages II-IV when compared to FIGO 2009 guidelines.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0090-8258 1095-6859 1095-6859
DOI:	10.1016/j.ygyno.2024.06.024