External Validation of the New 2023 International Federation of Gynecology and Obstetrics Staging System in Endometrial Cancer Patients: 12-Year Experience from an European Society of Gynecological Oncology-Accredited Center
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Characteristics
2.2. Patients
- Histological confirmation of endometrial cancer.
- Complete treatment at our hospital.
- Synchronous neoplasm.
- Recurrent endometrial cancer.
- Missing important registry data.
2.3. Data Collection
- Patient’s identifiers:
- ○
- Name.
- ○
- Hospital identification number.
- Patient’s age.
- Body Mass Index (BMI).
- Charlson Comorbidity Index (CCI).
- Histological type.
- Lymphovascular space invasion (LVSI).
- Tumor grade.
- FIGO staging (2009).
- FIGO staging (2023).
- Molecular classification:
- ○
- DNA polymerase epsilon (POLE) mutation.
- ○
- Mismatch repair-deficient subtype or microsatellite instability (MMRd or MSI).
- ○
- p53 abnormal (mutation type).
- Time-related data:
- ○
- Date of diagnosis.
- ○
- Date of recurrence.
- ○
- Date of last follow-up or death.
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Stage | Description |
---|---|
Stage I | Tumor confined to the corpus uteri |
IA | No or less than half myometrial invasion |
IB | Invasion equal to or more than half of the myometrium |
Stage II | Tumor invades cervical stroma but does not extend beyond the uterus |
Stage III | Local and/or regional spread of the tumor |
IIIA | Tumor invades the serosa of the corpus uteri and/or adnexa |
IIIB | Vaginal and/or parametrial involvement |
IIIC | Metastases to pelvic and/or para-aortic lymph nodes |
IIIC1 | Positive pelvic nodes |
IIIC2 | Positive para-aortic lymph nodes with or without positive pelvic lymph nodes |
Stage IV | Tumor invades bladder and/or bowel mucosa, and/or distant metastases |
IVA | Tumor invasion of bladder and/or bowel mucosa |
IVB | Distant metastases, including intra-abdominal metastases and/or inguinal lymph nodes |
Stage | Description |
---|---|
Stage I | Confined to the uterine corpus and ovary |
IA | Disease limited to the endometrium or non-aggressive histological type |
IAmPOLEmut | POLEmut endometrial carcinoma, confined to the uterine corpus or with cervical extension, regardless of LVSI or histological type |
IA1 | Non-aggressive histological type limited to an endometrial polyp or confined to the endometrium |
IA2 | Non-aggressive histological types involving less than half of the myometrium with no or focal LVSI |
IA3 | Low-grade endometrioid carcinomas limited to the uterus and ovary |
IB | Non-aggressive histological types with invasion of half or more of the myometrium and with no or focal LVSI |
IC | Aggressive histological types limited to a polyp or confined to the endometrium |
Stage II | Invasion of cervical stroma without extrauterine extension or with substantial LVSI or aggressive histological types with myometrial invasion |
IIA | Invasion of the cervical stroma of non-aggressive histological types |
IIB | Substantial LVSI of non-aggressive histological types |
IIC | Aggressive histological types with any myometrial involvement |
IICmp53abn | p53abn endometrial carcinoma confined to the uterine corpus with any myometrial invasion, with or without cervical invasion, and regardless of the degree of LVSI or histological type |
Stage III | Local and/or regional spread of the tumor of any histological subtype |
IIIA | Invasion of uterine serosa, adnexa, or both by direct extension or metastasis |
IIIA1 | Spread to ovary or fallopian tube (except when meeting stage IA3 criteria) |
IIIA2 | Involvement of uterine subserosa or spread through the uterine serosa |
IIIB | Metastasis or direct spread to the vagina and/or to the parametria or pelvic peritoneum |
IIIB1 | Metastasis or direct spread to the vagina and/or the parametria |
IIIB2 | Metastasis to the pelvic peritoneum |
IIIC | Metastasis to the pelvic or para-aortic lymph nodes or both |
IIIC1 | Metastasis to the pelvic lymph nodes |
IIIC1i | Micrometastasis |
IIIC1ii | Macrometastasis |
IIIC2 | Metastasis to para-aortic lymph nodes up to the renal vessels, with or without metastasis to the pelvic lymph nodes |
IIIC2i | Micrometastasis |
IIIC2ii | Macrometastasis |
Stage IV | Spread to the bladder mucosa and/or intestinal mucosa and/or distance metastasis |
IVA | Invasion of the bladder mucosa and/or the intestinal/bowel mucosa |
IVB | Abdominal peritoneal metastasis beyond the pelvis |
IVC | Distant metastasis, including metastasis to any extra- or intra-abdominal lymph nodes above the renal vessels, lungs, liver, brain, or bone |
Number of Patients (N) | Percentage (%) | ||
---|---|---|---|
Age (years) | mean: 63.5 | SD: 11.6 | |
BMI (kg/m2) | median: 32.8 | IQR: 28–38.2 | |
BMI categories | median: 2 | IQR: 1–4 | |
<18.5 | 0 | 53 | |
≥18.5–24.9 | 34 | 12.9 | |
≥25–29.9 | 59 | 13.7 | |
≥30–34.4 | 155 | 36.6 | |
≥35 | 55 | 12.8 | |
Missing | 168 | 39 | |
CCI | median: 3 | IQR: 2–4 | |
0–2 | 115 | 26.7 | |
3–4 | 179 | 41.5 | |
≥5 | 40 | 9.3 | |
Missing | 97 | 22.5 | |
Histology | |||
Carcinosarcoma | 14 | 3.2 | |
Clear cell | 6 | 1.4 | |
Endometrioid | 355 | 82.4 | |
Mixed | 18 | 4.2 | |
Mucinous | 2 | 0.5 | |
Serous | 31 | 7.2 | |
Undifferentiated | 5 | 1.2 | |
Grade | |||
Low | 306 | 71 | |
High | 125 | 29 | |
LVSI | |||
No | 343 | 79.6 | |
Focal | 43 | 10 | |
Substantial | 45 | 10.4 | |
Molecular subtypes | |||
MMRd | 7 | 1.6 | |
POLEmut | 11 | 2.6 | |
p53abn | 13 | 3 | |
NSMP | 2 | 0.5 | |
Unknown | 398 | 92.3 |
2009 FIGO | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
IA | IB | II | IIIA | IIIB | IIIC1 | IIIC2 | IVA | IVB | ||
2023 FIGO | n = 195 | n = 95 | n = 51 | n = 10 | n = 14 | n = 24 | n = 20 | n = 5 | n = 17 | |
IAmpolemut | n = 2 | 1 | 1 (↓) | - | - | - | - | - | - | - |
IA1 | n = 33 | 33 | - | - | - | - | - | - | - | - |
IA2 | n = 134 | 134 | - | - | - | - | - | - | - | - |
IA3 | n = 1 | - | - | - | 1 (↓) | - | - | - | - | - |
IB | n = 63 | - | 63 | - | - | - | - | - | - | - |
IC | n = 10 | 10 (↑) | - | - | - | - | - | - | - | - |
IIA | n = 33 | - | - | 33 | - | - | - | - | - | - |
IIB | n = 4 | 1 (↑) | 2 (↑) | 1 | - | - | - | - | - | - |
IIC | n = 59 | 16 (↑) | 27 (↑) | 16 | - | - | - | - | - | - |
IICmp53abn | n = 3 | - | 2 (↑) | 1 | - | - | - | - | - | - |
IIIA1 | n = 4 | - | - | - | 4 | - | - | - | - | - |
IIIA2 | n = 4 | - | - | - | 4 | - | - | - | - | - |
IIIB1 | n = 12 | - | - | - | - | 12 | - | - | - | - |
IIIB2 | n = 3 | - | - | - | 1 (↑) | 2 | - | - | - | - |
IIIC1i | n = 11 | - | - | - | - | - | 11 | - | - | - |
IIIC1ii | n = 13 | - | - | - | - | - | 13 | - | - | - |
IIIC2i | n = 3 | - | - | - | - | - | - | 3 | - | - |
IIIC2ii | n = 17 | - | - | - | - | - | - | 17 | - | - |
IVA | n = 5 | - | - | - | - | - | - | - | 5 | - |
IVB | n = 11 | - | - | - | - | - | - | - | - | 11 |
IVC | n = 6 | - | - | - | - | - | - | - | - | 6 (↑) |
2009 Stage | 2023 Stage | |||||
---|---|---|---|---|---|---|
Patients n (%) | 5-Year PFS in % (95% CI) | 5-Year OS in % (95% CI) | Patients n (%) | 5-Year PFS in % (95% CI) | 5-Year OS in % (95% CI) | |
I | 290 (67.3) | 83.3 (78.4, 88.4) | 86 (81.2, 91.2) | 243 (56.4) | 84 (78.9, 89.5) | 86.6 (81.5, 92.1) |
IA | 195 (45.2) | 87 (81.8, 92.5) | 88.7 (83.4, 94.3) | 150 (34.8) | 86.7 (81.2, 92.7) | 88.9 (83.3, 94.9) |
IAmpolemut | 2 (0.5) | n.e. | n.e. | |||
IA1 | 23 (5.3) | n.e. | n.e. | |||
IA2 | 124 (28.8) | 85.4 (79., 92.4) | 88.7 (82.5, 95.3) | |||
IA3 | 1 (0.3) | n.e. | n.e. | |||
IB | 95 (22.) | 74.7 (64.8, 86.2) | 80.2 (70.5, 91.3) | 63 (14.6) | 76.2 (64.7, 89.8) | 81 (69.7, 94.1) |
IC | 10 (2.3) | n.e. | n.e. | |||
II | 51 (11.8) | 57.2 (43.8, 74.6) | 62.8 (48.9, 80.7) | 99 (23.0) | 66.9 (56.7, 79.0) | 70.2 (59.6, 82.8) |
IIA | 33 (7.7) | 61 (45.3, 82.2) | 62.5 (46.5, 84.0) | |||
IIB | 4 (0.9) | n.e. | n.e. | |||
IIC | 59 (13.7) | 60.2 (45.4, 79.8) | 75.4 (61.9, 91.8) | |||
IICmp53abn | 3 (0.7) | n.e. | n.e. | |||
III | 68 (15.8) | 49.4 (36.4, 67.1) | 48.0 (34.8, 66.1) | 67 (15.5) | 49.3 (36.3, 67.0) | 47.9 (34.8, 66.0) |
IIIA | 10 (2.3) | n.e. | n.e. | 8 (1.9) | n.e. | n.e. |
IIIA1 | 4 (0.9) | n.e. | n.e. | |||
IIIA2 | 4 (0.9) | n.e. | n.e. | |||
IIIB | 14 (3.2) | 46.3 (21.3, 100) | 46.3 (21.3, 100) | 15 (3.5) | 46.8 (21.6, 100) | 46.8 (21.6, 100.0) |
IIIB1 | 12 (2.8) | 19.3 (23.0, 100) | 49.5 (19.3, 23.1) | |||
IIIB2 | 3 (0.7) | n.e. | n.e. | |||
IIIC | 44 (10.2) | 52.4 (37.3, 73.8) | 51.9 (36.4, 73.9) | |||
IIIC1 | 24 (5.6) | 48.3 (29.5, 79) | 51.2 (32.2, 81.3) | 24 (4.9) | 48.3 (29.5, 79) | 51.2 (32.2, 81.3) |
IIIC1i | 11 (2.6) | 60.6 (18.4, 33.4) | 37.9 (8.9, 100) | |||
IIIC1ii | 13 (3.0) | 55 (33.4, 90.6) | 33.2 (13.6, 81) | |||
IIIC2 | 20 (2.6) | 57.3 (35.7, 92.1) | 52.4 (30.0, 91.5) | 20 (4.6) | 52.4 (30.0, 91.5) | 52.4 (30.0, 96.5) |
IIIC2i | 3 (0.7) | n.e. | ||||
IIIC2ii | 17 (3.9) | 55 (33.4, 90.6) | 51.1 (28.9, 90.3) | |||
IV | 22 (5.1) | n.e. | n.e. | 22 (5.1) | n.e. | n.e |
IVA | 5 (1.2) | n.e. | n.e. | 5 (1.2) | n.e. | n.e. |
IVB | 17 (3.9) | n.e. | n.e. | 11 (2.6) | n.e. | n.e. |
IVC | 6 (1.4) | n.e. | n.e. |
Number of Patients (N) | Percentage (%) | ||
---|---|---|---|
Histology | |||
Carcinosarcoma | 3 | 6.2 | |
Clear cell | 2 | 4.2 | |
Endometrioid | 24 | 50 | |
Mixed | 10 | 20.8 | |
Mucinous | - | - | |
Serous | 8 | 16.7 | |
Undifferentiated | 1 | 2.1 | |
Grade | |||
Low | 7 | 14.6 | |
High | 41 | 85.4 | |
LVSI | |||
No | 30 | 62.5 | |
Focal | 13 | 27.1 | |
Substantial | 5 | 10.4 |
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Tsolakidis, D.; Zouzoulas, D.; Sofianou, I.; Karalis, T.; Chatzistamatiou, K.; Theodoulidis, V.; Topalidou, M.; Timotheadou, E.; Grimbizis, G. External Validation of the New 2023 International Federation of Gynecology and Obstetrics Staging System in Endometrial Cancer Patients: 12-Year Experience from an European Society of Gynecological Oncology-Accredited Center. Medicina 2024, 60, 1421. https://doi.org/10.3390/medicina60091421
Tsolakidis D, Zouzoulas D, Sofianou I, Karalis T, Chatzistamatiou K, Theodoulidis V, Topalidou M, Timotheadou E, Grimbizis G. External Validation of the New 2023 International Federation of Gynecology and Obstetrics Staging System in Endometrial Cancer Patients: 12-Year Experience from an European Society of Gynecological Oncology-Accredited Center. Medicina. 2024; 60(9):1421. https://doi.org/10.3390/medicina60091421
Chicago/Turabian StyleTsolakidis, Dimitrios, Dimitrios Zouzoulas, Iliana Sofianou, Tilemaxos Karalis, Kimon Chatzistamatiou, Vasilis Theodoulidis, Maria Topalidou, Eleni Timotheadou, and Grigoris Grimbizis. 2024. "External Validation of the New 2023 International Federation of Gynecology and Obstetrics Staging System in Endometrial Cancer Patients: 12-Year Experience from an European Society of Gynecological Oncology-Accredited Center" Medicina 60, no. 9: 1421. https://doi.org/10.3390/medicina60091421