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

Richard Schwameis; Francesco Fanfani; Christoph Ebner; Naomi Zimmermann; Inge Peters; Camilla Nero; Christian Marth; Robin Ristl; Katharina Leitner; Christoph Grimm; Felicitas Oberndorfer; Ilaria Capasso; Alain G Zeimet; Stephan Polterauer; Giovanni Scambia; Anna Fagotti; Nicole Concin

doi:10.1016/j.ejca.2023.113317

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. 2023 Nov:193:113317. doi: 10.1016/j.ejca.2023.113317. Epub 2023 Sep 1.

Authors

Richard Schwameis¹, Francesco Fanfani², Christoph Ebner³, Naomi Zimmermann⁴, Inge Peters⁵, Camilla Nero⁶, Christian Marth⁷, Robin Ristl⁸, Katharina Leitner⁹, Christoph Grimm¹⁰, Felicitas Oberndorfer¹¹, Ilaria Capasso¹², Alain G Zeimet¹³, Stephan Polterauer¹⁴, Giovanni Scambia¹⁵, Anna Fagotti¹⁶, Nicole Concin¹⁷

Affiliations

¹ Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: Richard.schwameis@meduniwien.ac.at.
² Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: francesco.fanfani@policlinicogemelli.it.
³ Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: Christoph.Ebner@i-med.ac.at.
⁴ Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: giannanaomi@gmail.com.
⁵ Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: ingepeters@live.nl.
⁶ Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: Camilla.nero@policlinicogemelli.it.
⁷ Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: Christian.marth@tirol-kliniken.at.
⁸ Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Austria. Electronic address: robin.ristl@meduniwien.ac.at.
⁹ Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: katharina.leitner@i-med.ac.at.
¹⁰ Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: Christoph.grimm@meduniwien.ac.at.
¹¹ Department of Pathology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: Felicitas.oberndorfer@meduniwien.ac.at.
¹² Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: capasso.ilaria@mayo.edu.
¹³ Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: alain.zeimet@i-med.ac.at.
¹⁴ Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecological Oncology, Gynecologic Cancer Unit, Comprehensive Cancer Center Vienna, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Electronic address: Stephan.polterauer@meduniwien.ac.at.
¹⁵ Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: giovanni.scambia@policlinicogemelli.it.
¹⁶ Department of Woman, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Institute of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: anna.fagotti@unicatt.it.
¹⁷ Department of Obstetrics and Gynecology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Electronic address: nicole.concin@i-med.ac.at.

PMID: 37748967
DOI: 10.1016/j.ejca.2023.113317

Abstract

Background: Recently, the new 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer (EC) critically integrating new pathological and molecular features was published. The present study evaluated the clinical impact of the new 2023 FIGO staging system by comparing it to the previous 2009 system.

Methods: This is an international, pooled retrospective study of 519 EC patients who underwent primary treatment (and molecular characterisation) at three European Society of Gynaecological Oncology (ESGO) accredited centres in Austria/Italy. Patients were categorised according to the 2009 and the 2023 FIGO staging systems. Stage shifts were analysed and (sub)stage specific 5-year progression-free (PFS) and overall survival (OS) rates were calculated and compared. Different statistical tests were applied to evaluate the prognostic precision of the two FIGO staging systems and to compare them to each other.

Results: (Sub)stage shifts occurred in 143/519 (27.6%) patients: 123 upshifts (23.7%) and 20 (3.9%) downshifts. 2023 FIGO staging system identified a stage I cohort with a notably higher 5-year PFS rate compared to 2009 (93.0% versus 87.4%, respectively). For stage II disease, the 5-year PFS rate was similar in the 2023 and the 2009 FIGO staging systems (70.2% versus 71.2%, respectively). The two new molecularly defined 2023 FIGO substages IAm_POLEmut and IICm_p53abn displayed distinct, particularly favourable and adverse oncologic outcomes within early stage disease, respectively. A remarkably lower 5-year PFS rate for stage III patients was revealed in the 2023 FIGO staging system compared to 2009 (44.4% versus 54.1%, respectively). All applied statistical tests confirmed a more accurate prediction of PFS and OS by the 2023 FIGO staging system compared to 2009.

Conclusion: The new 2023 FIGO stating system led to a substantial stage shift in about one quarter of patients leading to a higher prognostic precision. In early stage disease, the new substages added further prognostic granularity and identified treatment relevant subgroups.

Keywords: 2009 FIGO staging system; 2023 FIGO staging system; Endometrial cancer; Molecular classification; Prognostic precision; Stage shift.