2023 年子宫内膜癌（EC）FIGO 分期标准较 2009 年版本有显着变化。这些变化对患者诊断和治疗的全部影响尚不清楚。我们评估了两个系统之间分期和预后的差异，包括或不包括分子分类。我们将（1）FIGO 2009、（2）2023 分子不可知分期和（3）2023 分子知情分期分配给 404 个完全分期和分子分类的 EC 患者。通过 Kaplan-Meier 方法分析疾病特异性生存率和无进展/无复发生存率，并与时序检验进行比较；仅根据组织病理学结果，252 名（47%）FIGO 2009 I 期患者中的 118 名被升级。 I/II 期亚组生存分布分析显示，FIGO 2023 IIB 和 IIC 患者的预后较差。在分子信息的FIGO 2023系统中，15例POLE突变I/II期病例中的3例（20%）从FIGO 2009降级，8例（53%）从分子不可知的FIGO 2023降级。60例中的51例（ 85%）p53 异常肿瘤的分期较 2009 年的 FIFAO 提前，而 60 个肿瘤中的 13 个（22%）较 2023 年分子不可知分期的分期提前。分子分类改进了 2009 年和 2023 年 Figo 系统的预后分层。基于 POLE 突变的降期更准确地代表患者结果。然而，在缺乏已知 POLE 状态的情况下，对 I/II 期疾病应用分子不可知的FIGO 2023 标准应谨慎进行。对于侵袭性组织型，应考虑另外报告FIGO 2009分期。基于大量淋巴管间隙侵犯、任何子宫肌层侵犯的侵袭性组织型以及 p53 异常的升期可改善预后判断。 I/II 期的进一步细分提供了最少的额外预后信息。© 2024 John Wiley

The 2023 FIGO staging criteria for endometrial cancer (EC) introduced marked changes from the 2009 version. The full implication of these changes for patient diagnosis and treatment is unknown. We evaluate the differences in staging and prognostication between the two systems, with and without inclusion of molecular classification.We assigned (1) FIGO 2009, (2) 2023 molecular-agnostic and (3) 2023 molecular-informed stages to 404 fully staged and molecularly classified patients with EC. Disease-specific and progression/relapse-free survival were analysed via the Kaplan-Meier method and compared with log-rank testing; 118 of 252 (47%) FIGO 2009 stage I patients were upstaged based on histopathological findings alone. Stage I/II subgroup survival distribution analysis showed a worse prognosis in FIGO 2023 IIB and IIC patients. In the molecular-informed FIGO 2023 system, three of 15 (20%) POLE-mutated stage I/II cases were downstaged from FIGO 2009 and eight (53%) were downstaged from molecular-agnostic FIGO 2023. Fifty-one of 60 (85%) p53-abnormal tumours were upstaged from the FIGO 2009, whereas 13 of 60 (22%) were upstaged from the 2023 molecular-agnostic stage. Molecular classification improved prognostic stratification for both 2009 and 2023 FIGO systems.Downstaging based on POLE mutation more accurately represents patient outcomes. However, in the absence of known POLE status, applying molecular-agnostic FIGO 2023 criteria for stage I/II disease should be conducted with caution. For aggressive histotypes, additionally reporting FIGO 2009 stage should be considered. Upstaging based on substantial lymphovascular space invasion, aggressive histotype with any myometrial invasion and abnormal p53 improves prognostic discernment. Further subdivisions within stage I/II provide minimal additional prognostic information.© 2024 John Wiley & Sons Ltd.