Validation of the 2023 International Federation of Gynecology and Obstetrics staging system in a large retrospective cohort.
The aim of this study was to evaluate the prognostic performance of the revised 2023 International Federation of Gynecology and Obstetrics staging system for endometrial cancer compared with the 2009 system, with a particular focus on its ability to discriminate between intermediate- and advanced-stage disease.
This retrospective cohort study included 400 patients who underwent surgical treatment for endometrial cancer at a tertiary referral center between 2008 and 2018. Patients were reclassified according to both the International Federation of Gynecology and Obstetrics 2009 and 2023 criteria. Clinicopathological variables and survival outcomes were compared across staging systems. Kaplan-Meier curves with log-rank testing and Cox proportional hazards models were used to assess disease-free survival and overall survival. Harrell's concordance index and the Akaike Information Criterion were calculated to compare prognostic discrimination between staging systems.
International Federation of Gynecology and Obstetrics 2023 system demonstrated superior prognostic performance with significantly improved concordance index values for both disease-free survival (C-index 0.681 vs. 0.647, p=0.041) and overall survival (C-index 0.709 vs. 0.672, p=0.037). Five-year disease-free survival rates under International Federation of Gynecology and Obstetrics 2023 were 87.1, 75.9, and 52.3% for Stages I, II, and III-IV respectively, compared with 86.2, 71.8, and 52.3% under International Federation of Gynecology and Obstetrics 2009. Five-year overall survival rates showed similar improvement in Stage II discrimination (92.1, 79.2, and 58.7% for International Federation of Gynecology and Obstetrics 2023 vs. 91.3, 76.5, and 58.7% for International Federation of Gynecology and Obstetrics 2009).
The 2023 International Federation of Gynecology and Obstetrics staging system provides improved prognostic discrimination compared with the 2009 classification, particularly in delineating intermediate- from advanced-stage endometrial cancer. By incorporating adverse histopathological parameters and allowing integration of molecular classifiers, the revised system enables more accurate risk stratification and individualized treatment planning.
This retrospective cohort study included 400 patients who underwent surgical treatment for endometrial cancer at a tertiary referral center between 2008 and 2018. Patients were reclassified according to both the International Federation of Gynecology and Obstetrics 2009 and 2023 criteria. Clinicopathological variables and survival outcomes were compared across staging systems. Kaplan-Meier curves with log-rank testing and Cox proportional hazards models were used to assess disease-free survival and overall survival. Harrell's concordance index and the Akaike Information Criterion were calculated to compare prognostic discrimination between staging systems.
International Federation of Gynecology and Obstetrics 2023 system demonstrated superior prognostic performance with significantly improved concordance index values for both disease-free survival (C-index 0.681 vs. 0.647, p=0.041) and overall survival (C-index 0.709 vs. 0.672, p=0.037). Five-year disease-free survival rates under International Federation of Gynecology and Obstetrics 2023 were 87.1, 75.9, and 52.3% for Stages I, II, and III-IV respectively, compared with 86.2, 71.8, and 52.3% under International Federation of Gynecology and Obstetrics 2009. Five-year overall survival rates showed similar improvement in Stage II discrimination (92.1, 79.2, and 58.7% for International Federation of Gynecology and Obstetrics 2023 vs. 91.3, 76.5, and 58.7% for International Federation of Gynecology and Obstetrics 2009).
The 2023 International Federation of Gynecology and Obstetrics staging system provides improved prognostic discrimination compared with the 2009 classification, particularly in delineating intermediate- from advanced-stage endometrial cancer. By incorporating adverse histopathological parameters and allowing integration of molecular classifiers, the revised system enables more accurate risk stratification and individualized treatment planning.
Authors
Demirden Demirden, Keles Keles, Şanlıkan Şanlıkan, Özbay Özbay, Yıldız Yıldız, Mat Mat, Api Api
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