Background:ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) has brought about the publication of the FIGO 2023 staging system with a significant impact in practice for endometrial cancer (EC).Methods:In this comparative study, we investigated the need for adjuvant treatment according to FIGO 2023, for each FIGO 2009 stage. We prospectively enrolled EC patients from June 2021 to June 2024, collected classical risk factors and classified according to FIGO 2009. Afterwards, we reclassified the same women according to FIGO 2023 and grouped them according to ESMO/ESTRO/ESGO risk factors.Results:We collected 211 eligible patients. We found 176 patients with FIGO 2009 I–II and 35 women with FIGO 2009 III–IV. Based on classic anatomopathological risk factors and FIGO 2009, adjuvant treatment was indicated in 124 (70.5%) patients with FIGO 2009 I–II (vaginal brachytherapy = 48; external beam radiotherapy with or without vaginal brachytherapy = 63; chemotherapy with external beam radiotherapy with or without vaginal brachytherapy = 13) and in 35 (100%) women with FIGO 2009 III–IV (all underwent chemotherapy). After FIGO 2023 re-staging, the women with early-stage EC, were more frequently candidates for no treatment, with a decreased relative risk (RR) for adjuvant treatment (RR 0.84; CI95% 0.74–0.95;p< 0.01) when compared to the previous FIGO classification. No significant risk (RR 1.01; CI95% 0.76–1.3;p= 0.08) for a more aggressive adjuvant treatment was noted after FIGO 2023 re-staging. In FIGO stage III–IV, no changes in the treatment modalities were observed.Conclusions:The re-staging according to FIGO 2023 of women previously staged to FIGO 2009 I–II, yields an RR of 0.84 to spare any type of adjuvant treatment.
背景：子宫内膜癌分子风险前瞻性分类系统（ProMisE）推动了国际妇产科联盟（FIGO）2023分期系统的发布，对子宫内膜癌（EC）的临床实践产生了重要影响。方法：在这项比较研究中，我们针对每个FIGO 2009分期，探讨了根据FIGO 2023标准进行辅助治疗的必要性。我们前瞻性纳入了2021年6月至2024年6月期间的EC患者，收集传统风险因素并按FIGO 2009标准进行分类。随后，我们根据FIGO 2023标准对同一批患者进行重新分期，并依据欧洲肿瘤内科学会/欧洲放射肿瘤学会/欧洲妇科肿瘤学会（ESMO/ESTRO/ESGO）风险因素进行分组。结果：我们共收集了211例符合条件的患者。其中FIGO 2009 I–II期患者176例，FIGO 2009 III–IV期患者35例。基于传统解剖病理学风险因素和FIGO 2009标准，124例（70.5%）FIGO 2009 I–II期患者（阴道近距离放疗=48例；外照射放疗±阴道近距离放疗=63例；化疗联合外照射放疗±阴道近距离放疗=13例）和35例（100%）FIGO 2009 III–IV期患者（均接受化疗）需要辅助治疗。根据FIGO 2023标准重新分期后，早期EC患者更常被判定无需治疗，与既往FIGO分期相比，辅助治疗的相对风险（RR）显著降低（RR 0.84；95%CI 0.74–0.95；p<0.01）。FIGO 2023重新分期后，未发现需要更强辅助治疗的显著风险（RR 1.01；95%CI 0.76–1.3；p=0.08）。在FIGO III–IV期患者中，治疗方式未发生改变。结论：对原FIGO 2009 I–II期患者按FIGO 2023标准重新分期后，免除任何类型辅助治疗的相对风险为0.84。
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