Clinical outcomes and adjuvant therapy in stage IC endometrial cancer under the revised 2023 FIGO staging system - a multicenter analysis

Sep 22, 2026

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The revised 2023 FIGO staging system upstages endometrial cancers (ECs) without myometrial invasion but with aggressive histology from stage IA1 to stage IC; however, evidence for prognosis and treatment is limited. This multicenter retrospective study combined a Chinese cohort with the SEER database to evaluate overall survival (OS) and recurrence-free survival (RFS) and assess the effect of adjuvant therapy on stage IC outcomes. Stage IC showed worse 5-year RFS and OS than IA1, and adjuvant chemotherapy and/or radiotherapy did not improve survival, regardless of histologic subtype.

LanguageEnglish

CategoryHealthcare

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Abstract

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J Gynecol Oncol. 2026 May;37(3):e57 [https://doi.org/10.3802/jgo.2026.37.e57](https://doi.org/10.3802/jgo.2026.37.e57)[ ](https://doi.org/10.3802/jgo.2026.37.e57)pISSN 2005-0380·eISSN 2005-0399 Original Article Received: Mar 31, 2025 Revised: Jul 3, 2025 Accepted: Nov 27, 2025 Published online: Jan 12, 2026 Correspondence to Jie Yang Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. [Email: yangjie@tjh.tjmu.edu.cn](Email: yangjie@tjh.tjmu.edu.cn) *Xiaolin Meng and Jing Yuan have contributed equally to this work. © 2026. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https://)[ ](https://)[creativecommons.org/licenses/by-nc/4.0/](creativecommons.org/licenses/by-nc/4.0/)) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ORCID iDs Xiaolin Meng [https://orcid.org/0000-0002-5595-9871](https://orcid.org/0000-0002-5595-9871)[ ](https://orcid.org/0000-0002-5595-9871)Jing Yuan [https://orcid.org/0000-0002-0136-9331](https://orcid.org/0000-0002-0136-9331)[ ](https://orcid.org/0000-0002-0136-9331)Qian Zhang [https://orcid.org/0009-0000-3589-062X](https://orcid.org/0009-0000-3589-062X)[ ](https://orcid.org/0009-0000-3589-062X)Shuaiqingying Guo [https://orcid.org/0009-0002-1351-7597](https://orcid.org/0009-0002-1351-7597)[ ](https://orcid.org/0009-0002-1351-7597)Chaoyang Sun [https://orcid.org/0000-0003-2469-1638](https://orcid.org/0000-0003-2469-1638) Clinical outcomes and adjuvant therapy in stage IC endometrial cancer under the revised 2023 FIGO staging system: a multicenter analysis Xiaolin Meng ,1,2,* Jing Yuan ,1,2,* Qian Zhang ,1,2 Shuaiqingying Guo ,1,2 Chaoyang Sun ,1,2 Qing Zhang ,3 Yingmei Wang ,4 Kezhen Li ,1,2 Jihui Ai ,1,2 Jie Yang 1,2 1Department of Gynecological Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 2National Clinical Research Center for Obstetrics and Gynecology, Cancer Biology Research Center (Key Laboratory of the Ministry of Education), Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China 3Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China 4Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China ABSTRACT Objective: The revised 2023 International Federation of Gynecology and Obstetrics (FIGO) staging scheme for endometrial cancers (ECs) classifies tumors without myometrial invasion and with a non-aggressive histology as stage IA1, while those with aggressive histology are upgraded to stage IC. However, clinical guidelines lack evidence regarding prognostic and treatment strategies. This study evaluated survival outcomes of stage IC ECs and the impact of adjuvant therapy. Methods: Data from the Chinese cohort and the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curves and Cox-regression methods to assess treatment outcomes and identify risk factors. Results: Patients with stage IC had poorer 5-year-RFS (China: IA1 vs. IC, 97.5% vs 92.84%) and OS (SEER: IA1 vs. IC, 95.95% vs. 86.25%) than stage IA1. Despite 34/44 (77.3%) patients from China and 483/886 (54.5%) patients from SEER cohort received adjuvant therapy, no RFS (Chinese cohort, p=0.489) or OS (SEER cohort, p=0.560) improvement was observed, and neither chemotherapy, radiotherapy, nor their combination improved prognosis than no adjuvant therapy for ECs in stage IC ECs. Non-endometrioid histology

FAQs

How does the revised 2023 FIGO staging system affect stage assignment for endometrial cancer?

Tumors without myometrial invasion and with non-aggressive histology are classified as stage IA1, while those with aggressive histology are upgraded to stage IC.

What survival differences were observed between stage IC and stage IA1?

Stage IC had poorer 5-year recurrence-free survival and overall survival compared with stage IA1.

Did adjuvant chemotherapy or radiotherapy improve outcomes in stage IC ECs?

No. Across both Chinese and SEER cohorts, adjuvant therapy did not improve RFS or OS, and chemotherapy, radiotherapy, and their combination did not show benefit compared with no adjuvant therapy.

Sep 22, 2026

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