FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in endometrial cancer patients

Sep 23, 2026

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Objectives assess the prognostic value of the FIGO 2023 endometrial cancer staging system with or without molecular classification compared with FIGO 2009. Methods include 172 patients diagnosed between 2015 and 2020, with molecular subtypes assigned using DNA sequencing and immunohistochemistry. Clinical characteristics and survival outcomes were analyzed across POLEmut, MMRd, NSMP, and p53abn groups. Results evaluate stage migration and prognosis, showing POLE–EDM best RFS and OS, intermediate outcomes for MMRd/NSMP, and worst for p53abn.

LanguageEnglish

CategoryHealthcare

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Pages11

Reading Time28 min

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Abstract

Objectives

Methods

Results

Conclusions

Introduction

Background and rationale

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Materials and methods

Patients and data

Archives of Gynecology and Obstetrics (2026) 313:150 [https://doi.org/10.1007/s00404-026-08370-x](https://doi.org/10.1007/s00404-026-08370-x) FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in 172 endometrial cancer patients Ying Han1 · Ruxue Han1 · Xingran Jiang2 · Hong Qu1 · Jun Lu2 · Hua Li1 Received: 20 July 2025 / Accepted: 18 February 2026 © The Author(s) 2026 Abstract Objectives To evaluate the prognostic utility of the FIGO 2023 staging system with/without molecular classification vs. FIGO 2009 in endometrial cancer. Methods A total of 172 patients between 2015 and 2020 diagnosed with endometrial cancer in our center were included in this study. Molecular classification subtypes were classified using DNA sequencing and immunohistochemistry. The clinical characteristics and patients’ prognosis were analyzed. Results Of the 172 patients, 10 patients were classified to the POLEmut, 30 patients to the MMRd group, 106 patients to the NSMP group, and 26 patients to the p53abn group. Stage migration from FIGO 2009 to FIGO 2023 occurred in 27.3% of the patients (47/172). Among the 47 patients, upstaging from stage I to stage II was observed in 43 patients. The transition from stage III to the early stage occurred in 2 patients, with downstaging from stage III to IA3 . 9 patients were restaged as IAm disease with the FIGO 2023 m system. Downstaging to stage IAm was observed in 7 patients due to the presence of POLE mutation. In addition, 14 patients had stage IICm disease with the FIGO 2023 m. Eight patients were upstaged to stage IICm due to the presence of p53 abnormality, while 6 patients already exhibited stage IIC disease based on the FIGO 2023 classification. Patients with endometrial cancer with POLE–EDM had the best prognosis in terms of RFS and OS; those with MMRd and NSMP exhibited intermediate prognosis, with no significant difference between the two groups; and those with p53abn had the worst prognosis. Conclusions Molecular classification is prognostically essential in endometrial carcinoma. The integrated FIGO 2023 m system appears to enhance risk stratification relative to FIGO 2009 and non-molecular FIGO 2023. Formal comparison of staging systems is needed to confirm this improvement. Keywords Endometrial cancer · FIGO stage · Molecular classification Ying Han, Ruxue Han and Xingran Jiang authors contributed equally to this work. * Jun Lu[lujun0612@126.com](lujun0612@126.com) * Hua Li [hual_gyn@163.com](hual_gyn@163.com) 1 Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100023, China 2 Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100023, China What does this study adds to the clinical work Considering survival outcome, 2023 FIGO staging system stratifies patients more accurately than previous staging strategy. This study supports its feasibility in routine clinical practice to guide adjuvant therapy decisions and refine prognostic counseling for endometrial cancer patients. Introduction Endometrial cancer ranks as the fifth most common malignancy among women in China, with 89,200 new cases and 13,500 deaths annually according to 2024 data from the Chinese National Cancer Center [1] . Alarmingly, its incidence has surged by 121% over the past decade [2] . In 2023, the International Federation of Gynecology and Obstetrics (FIGO) Committee revised endometrial cancer staging to integrate molecular classification, as endorsed by European Society of Gynaecological Oncology (ESGO) and European Society for Radiotherapy and Oncology (ESTRO) guidelines [3] . This mandates molecular subtyping for all patients due to its critical prognostic value, categorizing tumors into four groups: POLEmutated (POLEmut), mismatch repair-deficient (MMRd), no specific molecular profile (NSMP), and p53-abnormal (TP53mut/p53abn) [3] . The incorporation of molecular data into

FAQs

What is the main objective of this study?

To evaluate whether the FIGO 2023 staging system, with or without molecular classification, provides better prognostic utility than FIGO 2009 in endometrial cancer patients.

How were molecular classification subtypes determined?

Molecular subtypes were classified using DNA sequencing and immunohistochemistry.

Which molecular group showed the best and worst prognosis?

Patients with POLE–EDM had the best prognosis in RFS and OS, while the p53abn group had the worst prognosis; MMRd and NSMP showed intermediate outcomes with no significant difference between them.

Sep 23, 2026

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