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PR043/#416  Restaging uterine cancer patients with the 2023 FIGO guidelines: clinical characteristics and survival differences
  1. Rosemary Senguttuvan1,
  2. Nicole Lugo Santiago1,
  3. Adrian Kohut1,
  4. Nora Ruel2,
  5. Jeff Lin1,
  6. Edward Wang3,
  7. Mihae Song1,
  8. Ernest Han1 and
  9. Joshua Cohen1
  1. 1City of Hope, Department of Surgery, Durate, USA
  2. 2City of Hope, Biostatistical Core, Durate, USA
  3. 3City of Hope, Medical Oncology, Duarte, USA


Introduction The landscape of endometrial cancer (EC) classification is undergoing a dramatic transformation as the disease moves towards molecularly driven categorization. Four molecular subtypes have been shown to portend different prognostic outcomes: POLE-hypermutated, p53 mutation, mismatch repair deficient (MMRd), and no specific molecular profile (NSMP). The recently released 2023 FIGO guidelines take into consideration histologic grade/subtype, lymphovascular invasion, and molecular categorization into staging.

Methods A retrospective review was conducted of EC patients treated between January 2018 and April 2023 at a comprehensive cancer center. Demographic information was collected, and patients were restaged according to the new guidelines. Molecular data was collected. Kaplan-Meyer progression free survival (PFS) 3-year estimates were conducted for subgroups.

Results 441 patients were included in analysis. 121 (27.4%) patients’ stages changed with the new guidelines; 118 patients were upstaged and 3 were downstaged. Upstaged patients originally stage IA had a significantly lower PFS compared to patients with no stage change (74.4% v 93.4%). A trend towards increased PFS was noted in early-stage patients when 2018 staging was compared to 2023 staging (stage I: 83.9% v 88.5%, p=0.2); stage II: 76.5% v 77.1%, p=0.6). Of the molecular data available, MMRd was the most common subtype (58/441, 13.2%) followed by p53 (57/441, 12.9%) and NSMP (51/441, 11.6%). p53 mutation negatively impacted PFS regardless of stage (stage I 28.9%, II 19.0%, III 39.4%, IV 11.7%).

Conclusion/Implications Restaging EC patients with the 2023 guidelines resulted in upstaging of a significant proportion of patients with resulting survival differences. p53 mutation impacted survival negatively regardless of stage.

Abstract PR043/#416 Table 1

Demographics and restaging information

Abstract PR043/#416 Figure 1

Progression free survival differences in early-stage patients with 2018 to 2023 staging comparison

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