A prognostic performance of 2023 FIGO for early-stage endometrial cancer staging

OBJECTIVES: Key changes in a revised version of FIGO endometrial cancer staging include a more detailed subdivision of stages I and II. The purpose of this study was to compare the clinical implications and prognostic performance of the 2009 and 2023 FIGO staging systems in predicting disease recurrence and survival in patients with early-stage endometrial cancer. MATERIALS AND METHODS: A retrospective cohort of 364 patients with early staged endometrial cancer patients who received primary surgery at King Chulalongkorn Memorial Hospital between October 2013-October 2018 were retrospectively staged according to 2009 and 2023 FIGO systems. 5-year Disease free interval, overall survival, and disease-specific survival were analyzed and compared. RESULTS: Using the 2023 FIGO classification led to changes in staging for 21.15% of cases when compared to the 2009 system, with all cases being reclassified to a more advanced stage. In multivariable Cox analysis, stage II disease under the 2023 criteria was linked to significantly higher risks of recurrence and death compared to stage I, with adjusted hazard ratios of 3.44 (95%CI 1.34-8.86) for disease-free interval, 5.18 (95%CI 1.35-19.80) for overall survival, and 18.54 (95%CI 2.67-128.81) for disease-specific survival-all with p-values below 0.003. Overall, the 2023 FIGO system tended to demonstrate better prognostic performance in predicting both recurrence and mortality compared to the 2009 framework. CONCLUSION: The updated 2023 FIGO staging system for early-stage endometrial cancer enhances prognostic precision and successfully distinguishes clinically meaningful subgroups. Even without molecular data, revised anatomical staging serves as a reliable tool for predicting recurrence and survival outcomes.