Staging for endometrial carcinoma FIGO 2023 and its relevance for clinical practice

Česká verze

Authors: B. Sehnal ¹; M. Kubecová ²; M. Hruda ¹; J. Drozenová ³; J. M. Halaška ¹; J. Havlík ²; H. Robová ¹; T. Pichlík ¹; K. Grafnetter Regináčová ²; L. Rob ¹
Authors place of work: Onkogynekologické centrum, Gynekologicko-porodnická klinika 3. LF UK a FN Královské Vinohrady, Praha ¹; Komplexní onkologické centrum, Onkologická klinika 3. LF UK a FN Královské Vinohrady, Praha ²; Ústav patologie 3. LF UK a FN Královské Vinohrady, Praha ³
Published in the journal: Klin Onkol 2024; 38(4): 250-258
Category: Přehledy
doi: https://doi.org/10.48095/ccko2024250

Summary

Background: International Federation of Gynaecology and Obstetrics (Fédération Internationale de Gynécologie et d’Obstétrique – FIGO) introduced a new staging system for endometrial carcinoma – FIGO 2023 – in June 2023. Objective: The new staging system differs significantly from previous versions. The new system represents a significant departure from the traditional staging systems for other gynaecological cancers, as the definition of individual stages includes not only the traditional anatomical extent of the tumour, but also the molecular profile of the tumour and other histopathological parameters – histological type of tumour, tumour grade and the presence of substantial lymphovascular invasion. The new system defines stages I and II in a completely different way and expands the definition of stages III and IV, allowing for different types of tumour spread outside the uterus. The introduction of molecular testing is the main change in the new staging system. When certain molecular markers are detected, stage I or II is completely changed. By including these non-anatomical parameters, the FIGO 2023 staging system improves the accuracy of a patient‘s prognosis at a specific stage with better options for individualized treatment, including the use of immunotherapy. Another goal was to synchronise staging as much as possible with the recommendations of three professional societies: the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP). The staging system for carcinosarcoma remains identical to the staging system for endometrial cancer. Conclusion: This article presents an overview of the new FIGO 2023 endometrial cancer staging system and discusses its advantages and disadvantages for clinical practice.

Keywords:

endometrial cancer – staging – molecular classification – FIGO 2023 staging system

Zdroje

1. Sung H, Ferlay J, Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (3): 209–249. doi: 10.3322/caac.21660.

2. Česky národní webový portál epidemiologie nádorů. Systém pro vizualizaci onkologických dat. Institut biostatistiky a analýz Lékařské a Přírodovědecké fakulty Masarykovy univerzity (IBA MU). Dostupné z: http: / / www.svod.cz.

3. Presl J, Vaněček T, Michal M et al. Molekulární klasifikace endometriálních karcinomů převedená do praxe. Ceska Gynekol 2021; 86 (4): 258–262.

4. Berek JS, Matias-Guiu X, Creutzberg C et al. Endometrial Cancer Staging Subcommittee, FIGO Women‘s Cancer Committee. FIGO staging of endometrial cancer: 2023. Int J Gynaecol Obstet 2023; 162 (2): 383–394. doi: 10.1002/ijgo.14923.

5. Hruda M, Sehnal B, Halaška MJ et al. Nový staging karcinomu endometria – FIGO 2023. Ceska Gynekol 2024; 89 (2): 120–127. doi: 10.48095/cccg2024120.

6. Vinklerová P, Felsinger M, Frydová S et al. Je nález hyperplazie či polypu děložní dutiny automatickou indikací k biopsii? Ceska Gynekol 2020; 85 (2): 84–93.

7. Concin N, Matias-Guiu X, Vergote I et al. ESGO/ESTRO/ ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021; 31 (1): 12–39. doi: 10.1136/ijgc-2020-002230.

8. Koblížková M, Bretová P, Felsinger M et al. Faktory zvyšující riziko malignity při nálezu endometriálního polypu v ultrazvukovém obraze. Ceska Gynekol 2024; 89 (1): 44–51.

9. Burg L, Timmermans M, van der Aa M et al. Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in the Netherlands. J Gynecol Oncol 2020; 31 (5): e58. doi: 10.3802/jgo.2020.31.e58.

10. Mueller JJ, Pedra Nobre S, Braxton K et al. Incidence of pelvic lymph node metastasis using modern FIGO staging and sentinel lymph node mapping with ultrastaging in surgically staged patients with endometrioid and serous endometrial carcinoma. Gynecol Oncol 2020; 157 (3): 619–623. doi: 10.1016/j.ygyno.2020.03.025.

11. Dundr P, Cibula D, Doležel M et al. Molekulární testování u karcinomu endometria – společné doporučení ČOS, onkogynekologické sekce ČGPS, SROBF a SČP ČLS JEP. Ceska Gynekol 2021; 86 (4): 264–272. doi: 10.48095/cccg2021264.

12. Kandoth C, Schultz N, Cherniack AD et al. Cancer Genome Atlas Research Network. Integrated genomic characterization of endometrial carcinoma. Nature 2013; 497 (7447): 67–73. doi: 10.1038/nature12113.

13. Stelloo E, Nout RA, Osse EM et al. Improved risk assessment by integrating molecular and clinicopathological factors in early-stage endometrial cancer-combined analysis of the PORTEC cohorts. Clin Cancer Res 2016; 22 (16): 4215–4224. doi: 10.1158/1078-0432.CCR-15- 2878.

14. Piulats JM, Guerra E, Gil-Martín M et al. Molecular approaches for classifying endometrial carcinoma. Gynecol Oncol 2017; 145 (1): 200–207. doi: 10.1016/j.ygyno.2016.12.015.

15. León-Castillo A, de Boer SM, Powell ME et al. Molecular classification of the PORTEC-3 trial for high-risk endometrial cancer: impact on prognosis and benefit from adjuvant therapy. J Clin Oncol 2020; 38 (29): 3388–3397. doi: 10.1200/JCO.20.00549.

16. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynae col Obstet 2009; 105 (2): 109. doi: 10.1016/j. ijgo.2009.02.010.

17. Sehnal B, Driák D, Kmonícková E et al. Současná klasifikace zhoubných nádorů v onkogynekologii – část II. Ceska Gynekol 2011; 76 (5): 360–366.

18. McCluggage WG, Bosse T, Gilks CB et al. FIGO 2023 endometrial cancer staging: too much, too soon? Int J Gynecol Cancer 2023; 34: 138–143. doi: 10.1136/ijgc-2023-004981.

19. Bosse T, Nout RA, McAlpine JN et al. Molecular classification of grade 3 endometrioid endometrial cancers identifies distinct prognostic subgroups. Am J Surg Pathol 2018; 42 (5): 561–568. doi: 10.1097/ PAS.00000 000000 01020.

20. Hejl Z, Hanáček J, Pilka R. Fertilitu zachovávající postupy u mladých žen s karcinomem endometria. Ceska Gynekol 2022; 87 (3): 202– 205.

21. Cree IA, White VA, Indave BI et al. Revising the WHO classification: female genital tract tumours. Histopathology. 2020; 76 (1): 151–156. doi: 10.1111/his.13 977.

22. Tortorella L, Restaino S, Zannoni GF et al. Substantial lymph-vascular space invasion (LVSI) as predictor of distant relapse and poor prognosis in low-risk early-stage endometrial cancer. J Gynecol Oncol 2021; 32 (2): e11. doi: 10.3802/jgo.2021.32.e11.

23. Weinberger V, Bednarikova M, Hausnerova J et al. A novel approach to preoperative risk stratification in endometrial C cancer: the added value of immunohistochemical markers. Front Oncol 2019; 9: 265. doi: 10.3389/fonc.2019.00265.

24. Visser NCM, van der Wurff AAM, IntHout J et al. Improving preoperative diagnosis in endometrial cancer using systematic morphological assessment and a small immunohistochemical panel. Hum Pathol 2021; 117: 68–78. doi: 10.1016/j.humpath.2021.08.006.

25. Bednaříková M, Hausnerová J, Minář L et al. Molekulární testování karcinomu endometria – analýza prvních zkušeností z klinické praxe. Klin Onkol 2023; 36 (3): 215–223. doi: 10.48095/ccko2023215.

26. 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 2023; 193: 113317. doi: 10.1016/j.ejca.2023. 113317.

27. Vinklerová P, Minář L, Weinberger V et al. Změna trendu operační léčby a stagingu lymfatických uzlin u karcinomu endometria – výsledky Onkogynekologického centra Gynekologicko-porodnické kliniky FN Brno a LF MU v letech 2012–2021. Ceska Gynekol 2022; 87 (5): 308–316.

28. Michal M, Valha P, Velemínský M. Detekce sentinelové lymfatické uzliny u karcinomu endometria – porovnání účinnosti robotického a laparoskopického detekčního systému. Ceska Gynekol 2023; 88 (3): 157–161. doi: 10.48095/cccg2023157.

29. Brych O, Drozenová J, Pichlík T et al. Předoperační a pooperační staging u karcinomu endometria – prospektivní studie. Ceska Gynekol. 2024; 89 (1): 5–10.