Background/Objectives: We comparatively evaluated the prognostic performance of the 2009 and 2023 International Federation of Gynecology and Obstetrics (FIGO) staging systems for early-stage endometrial cancer based on histological subtype stratification.Methods: A retrospective cohort of 472 patients with FIGO 2009 stage I–II between 2004 and 2019 was analyzed. Patients were restaged using both systems. Overall survival (OS) and recurrence-free survival (RFS) were determined according to histopathological aggressiveness. Kaplan–Meier survival analysis with log-rank testing compared the performance of the systems. Cox proportional hazards regression identified independent prognostic factors. A hypothetical modification of the FIGO 2023 system was evaluated for aggressive subtypes.Results: In all, 388 patients had nonaggressive histology, and 84 patients had aggressive histology. For cases of nonaggressive histology, FIGO 2023 demonstrated superior prognostic discrimination for OS and RFS (p< 0.05), whereas FIGO 2009 showed significant stratification for OS (p< 0.001) but not RFS (p= 0.149). For cases of aggressive histology, FIGO 2009 showed significant stratification for RFS (p= 0.017) but not OS (p= 0.31), whereas FIGO 2023 showed no significant stratification for either endpoint. The hypothetical modification of the FIGO 2023 staging system showed significantly improved discrimination for RFS (p= 0.019) but not OS. Multivariate analysis identified age and lymphovascular space invasion as independent prognostic factors in nonaggressive cancers, whereas cervical stromal involvement was significant in aggressive subtypes.Conclusions: The prognostic utility of the FIGO staging system is histology dependent. Although FIGO 2023 offers enhanced risk stratification for nonaggressive endometrial cancers, its discriminatory power for aggressive subtypes remains limited, indicating the need for histology-specific refinements of future staging frameworks.
背景/目的：本研究基于组织学亚型分层，对2009年与2023年国际妇产科联盟（FIGO）子宫内膜癌分期系统在早期病例中的预后效能进行对比评估。方法：回顾性分析2004年至2019年间472例FIGO 2009分期为I–II期患者的临床资料。采用两种分期系统对所有病例进行重新分期。根据组织病理学侵袭性评估总生存期（OS）和无复发生存期（RFS）。通过Kaplan-Meier生存分析与时序检验比较两种分期系统的效能，并采用Cox比例风险回归模型识别独立预后因素。针对侵袭性亚型，对FIGO 2023分期系统提出假设性修订方案并进行评估。结果：全组388例为非侵袭性组织学类型，84例为侵袭性组织学类型。在非侵袭性组织学病例中，FIGO 2023系统对OS和RFS均表现出更优的预后区分能力（p<0.05），而FIGO 2009系统仅对OS有显著分层效果（p<0.001），对RFS无显著分层（p=0.149）。在侵袭性组织学病例中，FIGO 2009系统对RFS有显著分层作用（p=0.017）但对OS无显著影响（p=0.31），而FIGO 2023系统对两项终点均未显示显著分层效果。对FIGO 2023分期系统的假设性修订显著提升了RFS的区分能力（p=0.019），但对OS改善不显著。多因素分析显示，在非侵袭性癌中年龄和淋巴血管间隙浸润是独立预后因素，而在侵袭性亚型中宫颈间质侵犯具有显著预后价值。结论：FIGO分期系统的预后效用具有组织学依赖性。虽然FIGO 2023系统提升了非侵袭性子宫内膜癌的风险分层能力，但其对侵袭性亚型的区分效能仍有限，提示未来分期框架需要针对组织学类型进行特异性优化。
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