Comparative analysis of European guideline-based clinicopathological risk groups and the International Federation of Gynecology and Obstetrics staging system for endometrial cancer

Objective: To investigate the correlation between endometrial cancer risk groups, as defined by the 2021 European guidelines, and the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system. Further, we aimed to evaluate the additional prognostic capability of the staging system within individual risk groups. Study design: This retrospective cohort study included patients who underwent primary treatment for endometrial cancer at a single tertiary center. Each case was classified into a molecular-integrated risk group according to the 2021 joint guidelines from the European Society of Gynaecological Oncology (ESGO), the European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP). Staging was performed using the FIGO 2023 criteria with molecular classification. Results: Data from 1044 patients were analyzed. Median follow-up was 70 months. Stage IA2, stage IB, and stage IVB were the most prevalent stages among the ESGO-ESTRO-ESP low-risk, intermediate risk, and advanced- metastatic groups, accounting for 80 %, 75 %, and 54 % of the cases, respectively. The stage distribution was more heterogeneous in the high-intermediate risk and high-risk groups, with stage IIA comprising 36 % and stage IICmp53abn comprising 35 % of cases in these groups. The FIGO staging system further stratified survival outcomes especially in the high-intermediate and high-risk groups. Stage IIC included a substantial number of cases from the intermediate risk (n = 23), high-intermediate risk (n = 48), and high-risk (n = 27) groups. Risk groups were associated with survival within this stage. Conclusions: ESGO-ESTRO-ESP high-intermediate risk and high-risk endometrial cancers exhibited the greatest variability in terms of stage distribution and survival outcomes. Stage IIC, the most heterogeneous stage concerning risk groups, showed an association between risk groups and survival.