Statistical Significance, Prognostic Precision of 2023 FIGO Staging System for Pre-Treated, Early-Stage Endometrial Cancer

According to results of a retrospective study, the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system led to statistically significant stage shifts and higher prognostic precision among patients with pre-treated, early-stage endometrial cancer. 

“Recently, the new 2023 FIGO staging system for endometrial cancer critically integrating new pathological and molecular features was published,” stated Richard Schwameis, Comprehensive Cancer Center Vienna, Vienna, Austria, and coauthors. “The present study evaluated the clinical impact of the new 2023 FIGO staging system by comparing it to the previous 2009 system.”

In this pooled, retrospective study, 519 patients with endometrial cancer who underwent primary treatment and molecular characterization at 3 European Society of Gynecological Oncology (ESGO) accredited centers in Austria and Italy were categorized and placed into cohorts according to 2009 and 2023 FIGO staging criteria. Patients were analyzed for stage shifts and substage specific 5-year progression-free survival (PFS) and overall survival (OS) rates. Statistical tests were used to compare and identify the prognostic precision of the 2 staging systems. 

At analysis, substage shifts occurred in 27.6% of patients, upshifts occurred in 23.7% of patients, and downshifts occurred in 3.9% of patients. The 5-year PFS rate for patients with stage 1 disease was notably higher with the 2023 staging system (93%), compared with the 2009 staging system (87.4%). The 5-year PFS for patients with stage 2 disease was 70.2% with the 2023 staging system and 71.2% with the 2009 staging system. For patients with stage 3 disease, the 5-year PFS rate was 44.4% with the 2023 staging system and 54.1% with the 2009 staging system. The 2 new molecularly defined substages, IAm_POLEmut and IICm_p53abn, displayed distinct favorable and adverse oncologic outcomes, respectively, among patients with early-stage disease. Statistical tests confirmed that the 2023 staging system led to more accurate PFS and OS prediction. 

“In early-stage disease the new substages added further prognostic granularity and identified treatment relevant subgroups,” concluded Dr Schwameis and coauthors. 

Source: 

Schwameis R, Fanfani F, Ebner C, et al. Verification of the prognostic precision of the new 2023 FIGO staging system in endometrial cancer patients– an international pooled analysis of three ESGO accredited centres. Eur J Cancer. Published online: August 31, 2023. doi:10.1016/j.ejca.2023.113317