Background/Objectives: To assess the impact of the 2023 FIGO staging revision on stage distribution, survival outcomes, and prognostic performance in endometrial cancer compared to the 2009 system. Methods: This retrospective cohort study analyzed 2969 patients with FIGO 2009 stage I–III endometrial cancer diagnosed at Samsung Medical Center (1994–2023). Patients were reclassified per the 2023 FIGO system. Stage migration, progression-free survival (PFS), and overall survival (OS) were evaluated. Prognostic performance was compared using the Akaike information criterion (AIC), Bayesian information criterion (BIC), concordance index (C-index), and area under the receiver operating characteristic curve (AUC). Results: Stage migration occurred in 20.2% of patients, with 98.3% involving upstaging from FIGO 2009 stage I, largely due to the inclusion of aggressive histology, p53 abnormality, and substantial lymphovascular space invasion (LVSI). The proportion of stage I tumors decreased from 81.5% to 65.2%, while stage II increased to 21.9%, including 14.8% newly classified as stage IIC. Patients remaining in stage I showed favorable outcomes (5-year PFS: 95.3%, OS: 98.5%), whereas those upstaged—especially to stage IIC—had significantly worse outcomes (5-year PFS: 76.5%, OS: 83.1%). Tumors with p53 abnormalities had poorer survival (PFS: 70.8%, OS: 76.6%). The 2023 FIGO system outperformed the 2009 system in prognostic discrimination across all metrics. Conclusions: The FIGO 2023 staging revision improves prognostic accuracy in endometrial cancer by integrating histopathologic and molecular risk factors. These refinements enhance risk stratification and may support more individualized treatment strategies.
背景/目的：评估2023年FIGO分期修订与2009年系统相比，对子宫内膜癌分期分布、生存结局及预后判断效能的影响。方法：本回顾性队列研究分析了三星医疗中心（1994–2023年）诊断为FIGO 2009分期I–III期的2969例子宫内膜癌患者。根据2023年FIGO系统对患者进行重新分期。评估了分期迁移、无进展生存期（PFS）和总生存期（OS）。使用赤池信息准则（AIC）、贝叶斯信息准则（BIC）、一致性指数（C-index）和受试者工作特征曲线下面积（AUC）比较预后判断效能。结果：20.2%的患者发生了分期迁移，其中98.3%涉及从FIGO 2009 I期上调分期，主要原因是纳入了侵袭性组织学类型、p53异常和显著的淋巴血管间隙浸润（LVSI）。I期肿瘤比例从81.5%降至65.2%，而II期比例增至21.9%，其中14.8%为新分类的IIC期。保持在I期的患者显示出良好的结局（5年PFS：95.3%，OS：98.5%），而分期上调的患者——特别是上调至IIC期者——结局显著更差（5年PFS：76.5%，OS：83.1%）。伴有p53异常的肿瘤生存率更差（PFS：70.8%，OS：76.6%）。在所有评估指标上，2023年FIGO系统的预后区分能力均优于2009年系统。结论：FIGO 2023分期修订通过整合组织病理学和分子风险因素，提高了子宫内膜癌的预后判断准确性。这些改进增强了风险分层，并可能支持更个体化的治疗策略。
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