根据2023年修订的FIGO指南重新分期子宫癌的预后影响：一项机构回顾性队列研究

Uterine cancer restaging according to the updated 2023 FIGO Guidelines does not uniformly affect prognosis: An institutional retrospective cohort study

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GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Oct

作者: R N Senguttuvan, N Lugo-Santiago, B Nakamura, M Song, E Han, N Ruel, D Cook, K Robinson, A Kohut, J G Cohen

DOI: 10.1016/j.ygyno.2024.06.024

摘要

为更好地进行风险分层，随着子宫内膜癌（EC）发病率的上升，2023年FIGO staging将组织学亚型和分子分类纳入EC的分期标准。我们旨在探讨新分期系统是否在预后预测方面优于2009年的分期系统。我们回顾性分析了2013年9月至2023年5月在我院治疗的EC患者资料，并结合公开的TCGA-2013数据集。详细临床信息被记录。根据2023年的指南对患者进行重新分期。采用Kaplan-Meier法估算生存率，log-rank检验比较无进展生存（PFS）曲线。共纳入919例患者，两个数据集在组织学等级、分期及诊断年龄方面具有可比性。其中，机构数据集175例（31.5%），TCGA数据集115例（31.6%）患者的分期发生变化。大多数分期变化的患者被升级（275/290，94.8%）。无分期变化的IA期患者与升级后患者的三年PFS分别为92.3%（95% CI：87.2, 95.4）与72.0%（95% CI：68.4, 84.9），差异具有统计学意义（p=0.002）。其他分期组未显示显著差异。EC患者中，原始分期为IA的患者升级后存在一定的生存差异，但在升级到II或III期后，生存差异不显著。需要改进风险评估以优化预后判断和辅助治疗方案。

Abstract

Efforts have been made to better risk stratify patients given the rise in incidence of endometrial cancer (EC). The 2023 FIGO staging now incorporates histologic subtype and molecular classification into determination of EC stage. We sought to elucidate if the new staging system demonstrated prognostic differences compared to the 2009 staging system.A retrospective chart review was performed on women treated for EC at our institution from September 2013 to May 2023 and combined with the publicly available TCGA Nature 2013 dataset. Detailed clinical information was captured. Patients were restaged according to the 2023 guidelines. Survival estimates were obtained using Kaplan-Meier method, and the log-rank test was used to compare survival curves for progression-free survival (PFS).919 patients were included in our analysis. The datasets were comparable regarding histologic grade, stage, and age at diagnosis. 175 (31.5%) of patients in the institution dataset and 115 (31.6%) patients in the TCGA dataset experienced a stage change. Most patients whose stage changed were upstaged (275/290; 94.8%). 3-year PFS estimates for stage IA patients with no stage change versus those upstaged were 92.3% (95% CI: 87.2, 95.4) v. 72.0% (95% CI: 68.4, 84.9), p = 0.002. No significant differences in survival difference were seen in other stage subsets.Modest survival differences exist in patients with EC originally staged as IA who underwent upstaging. No significant survival difference is observed in patients who are restaged to stage II or III subsets. Improved risk stratification is needed in assessing prognosis and adjuvant therapy for patients with endometrial cancer.