Decoding the 2023 FIGO Staging System in Endometrial Cancer: A Practical, Visually Guided Framework for Molecular Risk-Adapted Care Incorporating the 2025 Risk Group Update.
Summary
The FIGO staging system for endometrial cancer underwent a significant revision in 2023, incorporating refined anatomical criteria and molecular determinants. This update aims to optimize adjuvant treatment selection by maximizing therapeutic benefits while minimizing harm. Molecular subgroups include POLEmut, p53abn, MMRd, and NSMP. The 2025 ESGO-ESTRO-ESP recommendations further enhance this framework by mandating estrogen receptor (ER) assessment within the NSMP category, identifying early-stage disease with an increased risk of recurrence and mortality.
Analysis
This revision of the FIGO staging system, integrating molecular markers and ER status assessment, is crucial for clinical practice. It enables more precise risk stratification, facilitating individualized therapeutic decisions and improving multidisciplinary communication. By identifying dissemination and metastatic potential earlier and more accurately, it contributes to optimizing clinical outcomes and harmonizing staging across institutions, marking a significant step towards precision medicine in gynecological oncology.