Improved prognostic stratification with the FIGO 2023 endometrial cancer staging system. A multicenter Spanish cohort study.

To evaluate the impact of applying the FIGO 2023 staging system compared with FIGO 2009 in a real-world cohort of patients with early-stage endometrial cancer who underwent surgery. This multicenter retrospective cohort study included patients with apparent early-stage endometrial cancer diagnosed b...

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Bibliographic Details
Authors: Veiga, Nadia, Padilla Iserte, Pablo, Oliver, Reyes, Arencibia, Octavio, Díaz Feijoo, Berta, Gil Moreno, Antonio, Coronado, Pluvio J., Martín Salamanca, María Belén, Pantoja Garrido, Manuel, Marcos Sanmartin, Josefa, Gilabert Estellés, Juan, Lorenzo, Cristina, Cazorla, Eduardo, Cabezas, Elena, Roldán Rivas, Fernando, Rodríguez Hernández, José Ramón, Álvarez, Sara, Sánchez, Lourdes, Enguita German, Mónica, Muruzábal, Juan Carlos, SEGO Spain GOG Group
Format: article
Status:Versión aceptada para publicación
Publication Date:2026
Country:España
Institution:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repository:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:dnet:recercat____::a8fdcac7bd1102caa190495dc0a2733a
Online Access:https://hdl.handle.net/2445/228553
Access Level:Embargoed access
Keyword:Càncer d'endometri
Endoscòpia
Càncer de mama
Endometrial cancer
Endoscopy
Breast cancer
Description
Summary:To evaluate the impact of applying the FIGO 2023 staging system compared with FIGO 2009 in a real-world cohort of patients with early-stage endometrial cancer who underwent surgery. This multicenter retrospective cohort study included patients with apparent early-stage endometrial cancer diagnosed between 2000 and 2020 across 18 Spanish centers. All patients underwent primary surgery and were classified according to both FIGO 2009 and FIGO 2023 criteria. Stage migration was assessed, and the characteristics of newly defined subgroups were described. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were compared between classifications. A total of 4566 patients were included. Application of the FIGO 2023 system resulted in stage migration in 909 patients (19.9%) compared with FIGO 2009. The FIGO 2023 system showed a higher 5-year OS for Stage I patients than the 2009 classification (91.3% vs. 88.2%). Within the new substages, 5-year OS was 93.9% in Stage IA1 and 91.9% in Stage IA2, and Stage IA3 demonstrated distinct survival outcomes. Overall survival for Stage III remained comparable between classifications, although outcomes varied across subcategories. In a simplified classification (Stages I-III), the FIGO 2023 system showed improved prognostic discrimination for both PFS and OS according to Harrell's C-index. The FIGO 2023 staging system leads to substantial reclassification of early-stage endometrial cancer patients and introduces new prognostic subgroups. This increased granularity improves prognostic stratification and may support individualized treatment decisions, even when molecular testing is limited.

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