Article Text
Abstract
Introduction FIGO 2023 staging of endometrial cancers (ECs) encourages integration of molecular classification with traditional pathologic features for better prognostic risk-group stratification and improved treatment decisions (de-escalation or intensive management). We implemented the FIGO 2023 staging system in a series of ECs [complemented by complete morpho-molecular profiling in a subset of cases], and compared results vis à vis FIGO 2009 staging.
Methods 124 ECs were staged using FIGO 2023 and FIGO 2009 staging systems. Complete molecular categorization as per WHO algorithm was carried out in a subset (40/124) of cases, using POLE mutation testing [using Sanger sequencing for four pathogenic POLE mutations], and immunohistochemistry for p53, and Mismatch repair (MMR) proteins.
Results Significant stage shifts were noted using FIGO 2023, vis a vis FIGO 2009 staging system, impacting chiefly low stage (Stage I and II) ECs, with stage upshifts predominating over downshifts. Without molecular categorization (84/124 cases), FIGO 2023 upshifted tumor stage in 11.9% and downshifted in 1.1% cases. Complimenting morphology with molecular categorization increased the proportion of stage shifts by 2.4%, with 15% upshifts and 2.5% downshifts. These results are detailed in table 1 and figure 1. Both morphology (aggressive histologic subtype, substantial lymphovascular invasion, tumor location) and molecular profile (p53abn and POLE mutation) contributed to stage shifts.
Conclusion/Implications Addition of molecular subtyping increased the proportion of stage shifts in FIGO 2023 staging system in this study. Our study endorses integrated molecular diagnosis in ECs (especially in aggressive histologic subtypes) for higher prognostic precision using FIGO 2023 staging system.