New staging of endometrial carcinoma – FIGO 2023

Download PDF Czech version

Authors: Martin Hruda ¹; Borek Sehnal ¹; Michael Jiří Halaška ¹; J. Drozenová ²; H. Robová ¹; T. Pichlík ¹; Lukáš Rob ¹
Authors‘ workplace: Onkogynekologické centrum, Gynekologicko-porodnická klinika 3. LF UK a FNKV, Praha ¹; Ústav patologie, 3. LF UK a FNKV, Praha ²
Published in: Ceska Gynekol 2024; 89(2): 120-127
Category:
doi: https://doi.org/10.48095/cccg2024120

Overview

Aim: To review the changes in the new version of the FIGO 2023 staging system for endometrial cancer. Methods and results: The new FIGO 2023 endometrial cancer staging system provides key updates for the diagnosis and treatment of endometrial cancer. An important step in diagnosis is molecular classification, which allows more accurate risk stratification for recurrence and the identification of targeted therapies. The new staging system, based on the recommendations of the international societies ESGO, ESTRO and ESP, incorporates not only the description of the pathological and anatomical extent of the disease, but also the histopathological characteristics of the tumour, including the histological type and the presence of lymphovascular space invasion. In addition, the staging system uses molecular testing to classify endometrial cancers into four prognostic groups: POLEmut, MMRd, NSMP and p53abn. Each group has its own specific characteristics and prognosis. The most significant changes have occurred in stages I and II, in which the sub-staging better reflects the biological behaviour of the tumour. This update increases the accuracy of prognosis and improves individualized treatment options for patients with endometrial cancer. Conclusion: The updated FIGO staging of endometrial cancer for 2023 incorporates different histologic types, tumour features, and molecular classifications to better reflect the current improved understanding of the complex nature of several endometrial cancer types and their underlying bio logic behaviour. The aim of the new endometrial cancer staging system is to better define stages with similar prognosis, allowing for more precise indication of individualised adjuvant radiation or systemic treatment, including the use of immunotherapy.

Keywords:

endometrial cancer – staging – FIGO – molecular classification – update

Sources

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. Sant M, Chirlaque Lopez MD, Agresti R et al. Survival of women with cancers of breast and genital organs in Europe 1999–2007: results of the EUROCARE-5 study. Eur J Cancer 2015; 51 (15): 191–205. doi: 10.1016/j.ejca.2015.07. 022.

3. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. Masarykova univerzita. 2007 [online]. Dostupné z: http: //www.svod.cz.

4. Presl J, Vaněček T, Michal M et al. Molekulární klasifikace endometriálních karcinomů převedená do praxe. Ceska Gynekol 2021; 86 (4): 258–262. doi: 10.48095/cccg2021258.

5. 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.

6. 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.

7. Berek JS, Matias‐Guiu X, Creutzberg C et al. FIGO staging of endometrial cancer: 2023. Int J Gynecol Obstet 2023; 162 (2): 383–394. doi: 10.1002/ijgo.14923.

8. 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.

9. 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.

10. Talhouk A, McConechy MK, Leung S et al. A clinically applicable molecular-based classification for endometrial cancers. Br J Cancer 2015; 113 (2): 299–310. doi: 10.1038/bjc.2015.190.

11. Talhouk A, McConechy MK, Leung S et al. Confirmation of ProMisE: a simple, genomics-based clinical classifier for endometrial cancer. Cancer 2017; 123 (5): 802–813. doi: 10.1002/cncr. 30496.

12. 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.

13. 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.

14. 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.

15. Kommoss S, McConechy MK, Kommoss F et al. Final validation of the ProMisE molecular classifier for endometrial carcinoma in a large population-based case series. Ann Oncol 2018; 29 (5): 1180–1188. doi: 10.1093/annonc/mdy058.

16. Horeweg N, de Bruyn M, Nout RA et al. Prognostic integrated image-based immune and molecular profiling in early-stage endometrial cancer. Cancer Immunol Res 2020; 8 (12): 1508–1519. doi: 10.1158/2326-6066.CIR-20-0149.

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

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

19. 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.

20. 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. doi: 10.48095/cccg2022308.

21. 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.

22. 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.00000000000 01020.

23. Assem H, Rottmann D, Finkelstein A et al. Minimal uterine serous carcinoma and endometrial polyp: a close clinicopathological relationship. Hum Pathol 2021; 118: 1–8. doi: 10.1016/ j.humpath.2021.09.001.

24. Xu H, Cui SS, Ran L et al. Incidence of omental metastasis in uterine serous carcinoma: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2022; 51 (6): 102395. doi: 10.1016/j.jogoh.2022.102395.

25. Bosse T, Peters EE, Creutzberg CL et al. Substantial lymph-vascular space invasion (LVSI) is a significant risk factor for recurrence in endometrial cancer – a pooled analysis of PORTEC 1 and 2 trials. Eur J Cancer 2015; 51 (13): 1742–1750. doi: 10.1016/j.ejca.2015.05.015.

26. 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.

27. Zhan X, Li L, Wu M et al. The prognosis of stage IA synchronous endometrial endometrioid and ovarian carcinomas. Arch Gynecol Obstet 2019; 300 (4): 1045–1052. doi: 10.1007/s00404-019-05288-5.

28. Veade AE, Foote J, Ehrisman J et al. Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma. World J Surg Oncol 2019; 17 (1): 80. doi: 10.1186/s12957-019-1620-x.

29. Anglesio MS, Wang YK, Maassen M et al. Synchronous endometrial and ovarian carcinomas: Eevidence of clonality. J Natl Cancer Inst 2016; 108 (6): djv428. doi: 10.1093/jnci/djv428.

30. WHO Classification of Tumours Editorial Board. Female Genital Tumours. Lyon: International Agency for Research on Cancer 2020.

31. Turashvili G, Gómez-Hidalgo NR, Flynn J et al. Risk-based stratification of carcinomas concurrently involving the endometrium and ovary. Gynecol Oncol 2019; 152 (1): 38–45. doi: 10.1016/j.ygyno.2018.10.033.

32. 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.

33. 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.

34. 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.

35. Hejl Z, Hanáček J, Pilka R. Fertilitu zachovávající postupy u mladých žen s karcinomem endometria. Ceska Gynekol 2022; 87 (3): 202–205. doi: 10.48095/cccg2022202.

ORCID autorů

M. Hruda 0000-0002-7606-5164

B. Sehnal 0000-0003-2622-2181

M. J. Halaška 0000-0001-6055-2569

J. Drozenová 0009-0005-5695-1221

H. Robová 0000-0002-6136-7602

T. Pichlík 0000-0001-6732-1421

L. Rob 0000-0003-3770-651X

Doručeno/Submitted: 31. 12. 2023

Přijato/Accepted: 16. 1. 2024

as. MUDr. Martin Hruda, Ph.D.

Gynekologicko-porodnická klinika