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Predictive value of the new ESGO-ESTRO-ESP endometrial cancer risk classification on survival and recurrence in the Danish population
  1. Gitte Ortoft1,
  2. Claus Høgdall1,
  3. Estrid Stæhr Hansen2 and
  4. Margit Dueholm3
  1. 1Department of Gynecology, Copenhagen University Hospital, Copenhagen, Denmark
  2. 2Department of Histopathology, Aarhus Universitetshospital, Aarhus, Denmark
  3. 3Department of Gynecology and Obstetrics, Aarhus Universitetshospital, Aarhus, Denmark
  1. Correspondence to Dr Gitte Ortoft, Department of Gynecology, Copenhagen University Hospital, 2100 Copenhagen, Denmark; ortoft{at}


Objective To compare the performance of the new ESGO-ESTRO-ESP (European Society of Gynecological Oncology-European Society for Radiotherapy & Oncology-European Society for Pathology) 2020 risk classification system with the previous 2016 risk classification in predicting survival and patterns of recurrence in the Danish endometrial cancer population.

Methods This Danish national cohort study included 4516 patients with endometrial cancer treated between 2005 and 2012. Five-year Kaplan–Meier adjusted and unadjusted survival estimates and actuarial recurrence rates were calculated for the previous and the new classification systems.

Results In the 2020 risk classification system, 81.0% of patients were allocated to low, intermediate, or high-intermediate risk compared with 69.1% in the 2016 risk classification system, mainly due to reclassification of 44.5% of patients previously classified as high risk to either intermediate or especially high-intermediate risk. The survival of the 2020 high-risk group was significantly lower, and the recurrence rate, especially the non-local recurrence rate, was significantly higher than in the 2016 high risk group (2020/2016, overall survival 59%/66%; disease specific 69%/76%; recurrence 40.5%/32.3%, non-local 34.5%/25.8%). Survival and recurrence rates in the other risk groups and the decline in overall and disease-specific survival rates from the low risk to the higher risk groups were similar in patients classified according to the 2016 and 2020 systems.

Conclusion The new ESGO-ESTRO-ESP 2020 risk classification system allocated fewer patients to the high risk group than the previous risk classification system. The main differences were lower overall and disease-specific survival and a higher recurrence rate in the 2020 high risk group. The introduction of the new 2020 risk classification will potentially result in fewer patients at high risk and allocation to the new high risk group will predict lower survival, potentially allowing more specific selection for postoperative adjuvant therapy.

  • endometrial neoplasms

Data availability statement

Data are available upon reasonable request. Data are part of the mandatory Danish Gynecological Cancer Database which is part of the Danish Health System.

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Data availability statement

Data are available upon reasonable request. Data are part of the mandatory Danish Gynecological Cancer Database which is part of the Danish Health System.

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  • Contributors All authors declare they participated in this manuscript. Contribution to authorship: conception: GØ, CH, MD; planning: GØ, CH, ESH, MD; carrying out study: GØ, CH, ESH, MD; analysing and writing: GØ, CH, ESH, MD.

  • Funding The study was financially supported by the Health Research Fund of Copenhagen University Hospital and Hans & Nora Buchard’s Fund.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.