Authors: Martin Hruda 1; Radoslav Matěj 2,3,4; Borek Sehnal 1; Jana Drozenová 2; Helena Robová 1; Tomáš Pichlík 1; Michael J. Halaška 1; Lukáš Rob 1; Pavel Dundr 4 Authors‘ workplace: Gynekologicko-porodnická klinika, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha 1; Ústav patologie, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha 2; Ústav patologie a molekulární medicíny, Fakultní Thomayerova nemocnice a 3. lékařská fakulta Univerzity Karlovy, Praha 3; Ústav patologie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha 4 Published in: Čes.-slov. Patol., 62, 2026, No. 1, p. 35-42 Category: Reviews Article
The Czech Republic is one of the countries with the highest incidence of endometrial cancer in the world. In June 2023, the Women’s Cancer Committee of the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new staging system for endometrial cancer, FIGO 2023, which replaced the 2009 version. The FIGO 2023 staging system differs significantly from the previous version by incorporating the result of molecular classification of the tumour and some histopathological parameters - histological type of tumour, tumour grade and presence of substantial lymphovascular invasion - into the definitions of stage I and stage II. For stage I and II tumours, specific separate stages are reserved when the molecular profile of POLEmut or TP53mut is detected. Stages III and IV have also been modified, but the result of the molecular classification of the tumour and other histopathological parameters do not influence the staging. However, the molecular classification result should be reported for all stages. These changes have further strengthened the role of the pathologist in staging. The changes, which are partly based on the recommendations of the three European professional societies ESGO/ESTRO/ESP for the diagnosis and treatment of endometrial cancer, better reflect the biological behaviour of the tumour and significantly refine the prognosis of the patient at a given stage. On the other hand, the FIGO 2023 staging system is quite complex and requires expensive tests, which may pose a problem for its routine use in a global context. The implementation of the FIGO 2023 endometrial cancer staging system in daily practice requires the full involvement of all stakeholders.
endometrial cancer – staging – molecular classification – staging system – FIGO 2023 – LVSI – controversies
1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA A Cancer J Clin 2021; 71(3): 209–249.
2. Presl J, Vaněček T, Michal M, et al. Molekulární klasifikace endometriálních karcinomů převedená do praxe. Ceska Gynekol 2021; 86(4): 258–262.
3. Krejčí D, Mužík J, Šnábl I, Gregor J, Komenda M, Dušek L. Portál epidemiologie novotvarů v ČR [online]. Masarykova univerzita, Brno, 2024. [cit. 2025-01-05]. Dostupný z: https://www.svod.cz.
4. Vinklerová P, Minář L, Weinberger V, Felsinger M, Koblížková M. Změna trendu operační léčby a stagingu lymfatických uzlin u karcinomu endometria – výsledky Onkogynekologického centra Gynekologicko-porodnické kliniky FN Brno a LF MU v letech 2012 – 2021. Ceska Gynekol 2022; 87(5): 308–316.
5. Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2021; 31(1): 12–39.
6. Koblížková M, Bretová P, Felsinger M, et al. Faktory zvyšující riziko malignity při nálezu endometriálního polypu v ultrazvukovém obraze. Ceska Gynekol 2024; 89(1): 44–51.
7. Berek JS, Matias‐Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. J Gynecol Oncol 2023; 34(5): e85.
8. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet 2009; 105(2): 109.
9. Sehnal B, Benková K, Kmoníčková E, et al. Současný staging zhoubných nádorů děložního těla a jeho význam pro klinickou praxi Cesk Patol 2014; 50(2): 100–105.
10. Anglesio MS, Wang YK, Maassen M, et al. Synchronous Endometrial and Ovarian Carcinomas: Evidence of Clonality. J Natl Cancer Inst 2016; 108: djv428.
11. Hájková N, Tichá I, Hojný J, et al. Synchronous endometrioid endometrial and ovarian carcinomas are biologically related: A clinico - -pathological and molecular (next generation sequencing) study of 22 cases. Oncol Lett 2019; 17(2) :2207–2214.
12. Cree IA, White VA, Indave BI, et al. Revising the WHO classification: female genital tract tumours. Histopathology 2020; 76(1): 151 - 156.
13. Schwameis R, Fanfani F, Ebner C, et al. Verification of the prognostic precision of the new 2023 FIGO staging system in endometrial cancer patients - An international pooled analysis of three ESGO accredited centres. Eur J Cancer Oxf Engl 2023; 193 : 113317.
14. Burg L, Timmermans M, van der Aa M, et al. Incidence and predictors of peritoneal metastases of gynecological origin: a population-based study in the Netherlands. J Gynecol Oncol 2020; 31: e58.
15. Dundr P, Cibula D, Doležel M, et al. Molekulární testování u karcinomu endometria (společné doporučení ČOS, onkogynekologické sekce ČGPS, SROBF a SČP ČLS JEP). Cesk Patol 2021; 57(3): 181–187.
16. Kandoth C, Schultz N, Cherniack AD, et al. Cancer Genome Atlas Research Network. Integrated genomic characterization of endometrial carcinoma. Nature 2013; 497(7447): 67–73.
17. Stelloo E, Nout RA, Osse EM, et al. Improved risk assessment by integrating molecular and clinicopathological factors in early-stage endometrial cancer-combined analysis of the PORTEC cohorts. Clin Cancer Res 2016; 22(16): 4215–4224. 18. León-Castillo A, de Boer SM, Powell ME, et al. Molecular classification of the PORTEC-3 trial for high-risk endometrial cancer: impact on prognosis and benefit from adjuvant therapy. J Clin Oncol 2020; 38(29): 3388–3397. 19. Piulats JM, Guerra E, Gil-Martín M, et al. Molecular approaches for classifying endometrial carcinoma. Gynecol Oncol 2017; 145(1): 200–207. 20. De Leo A, de Biase D, Lenzi J, et al. ARID1A and CTNNB1/β-Catenin Molecular Status Affects the Clinicopathologic Features and Prognosis of Endometrial Carcinoma: Implications for an Improved Surrogate Molecular Classification. Cancers (Basel) 2021; 13(5): 950.
21. McCluggage WG, Bosse T, Gilks CB, et al. FIGO 2023 endometrial cancer staging: too much, too soon? Int J Gynecol Cancer 2024; 34 : 138–143.
22. Dvořák O, Slavíčková M, Laco J, et al. DNA hypermetylace tumor supresorových genů TWIST1, GATA4, MUS81 a NTRK1 u hyperplázie endometria. Ceska Gynekol 2024; 89(4): 261–268.
23. Michalová K, Presl J, Straková-Peteříková A, et al. Výhody genetického sekvenování nové generace (NGS) v molekulární klasifikaci endometriálních karcinomů: Naše zkušenosti s 270 případy. Ceska Gynekol 2024; 89 : 349–359.
24. Smithgall MC, Remotti H, Hsiao SJ, et al. Investigation of discrepant mismatch repair immunohistochemistry and microsatellite instability polymerase chain reaction test results for gynecologic cancers using next-generation sequencing. Hum Pathol 2022; 119 : 41–50.
25. Cui J, Chen X, Zhai Q, et al. A novel somatic mutation in POLE exonuclease domain associated with ultra-mutational signature and MMR deficiency in endometrial cancer: a case report. Diagn Pathol 2023; 18 : 19.
26. Ondič O, Michalová K, Švajdler M, et al. Molecular substratification of endometrial carcinomas with no special molecular profile (NSMP) by using a limited NGS custom panel may facilitate effective patient selection for the PIK3CA-targeted therapy. Virchows Arch. In press 2024.
27. Espinosa I, D’Angelo E, Prat J. Endometrial carcinoma: 10 years of TCGA (the cancer genome atlas): A critical reappraisal with comments on FIGO 2023 staging. Gynecol Oncol 2024; 186 : 94–103.
28. Köbel M, Ronnett BM, Singh N, et al. Interpretation of P53 Immunohistochemistry in Endometrial Carcinomas: Toward Increased Reproducibility. Int J Gynecol Pathol 2019; 38 (Suppl 1): 123–131.
29. Huvila J, Thompson EF, Vanden Broek J, et al. Subclonal p53 immunostaining in the diagnosis of endometrial carcinoma molecular subtype. Histopathology 2023; 83(6): 880–890. 30. Dundr P, Němejcová K, Bártů M, et al. Význam imunohistochemických metod v diagnostice karcinomu endometria. Cesk Patol 2021; 57(2): 73–85.
31. León-Castillo A, Gilvazquez E, Nout R, et al. Clinicopathological and molecular characterisation of „multiple-classifier“ endometrial carcinomas. J Pathol 2020; 250 : 312–322.
32. Michalová K, Straková-Peteříková A, Ondič O, et al. Next-generation sequencing in the molecular classification of endometrial carcinomas: Experience with 270 cases suggesting a potentially more aggressive clinical behavior of multiple classifier endometrial carcinomas. Virchows Arch 2025; 487(1): 141-152.
33. De Vitis LA, Schivardi G, Caruso G, et al. Clinicopathological characteristics of multiple - -classifier endometrial cancers: a cohort study and systematic review. Int J Gynecol Cancer 2024; 34 : 229–238.
34. Visser NCM, van der Wurff AAM, IntHout J, et al. Improving preoperative diagnosis in endometrial cancer using systematic morphological assessment and a small immunohistochemical panel. Hum Pathol 2021; 117 : 68–78.
35. Weinberger V, Bednaříková M, Hausnerová J, et al. A novel approach to preoperative risk stratification in endometrial cancer: the added value of immunohistochemical markers. Front Oncol 2019; 9 : 265.
36. Vrede SW, van Weelden WJ, Visser NCM, et al. Immunohistochemical biomarkers are prognostic relevant in addition to the ESMO - -ESGO-ESTRO risk classification in endometrial cancer. Gynecol Oncol 2021; 161 : 787–794.
37. Abada E, Kim S, Jang H, et al. Human epidermal growth factor receptor-2 (HER2) expression in FIGO3 high-grade endometrial endometrioid carcinoma: Clinicopathologic characteristics and future directions. Gynecol Oncol 2024; 185 : 25–32.
38. Veade AE, Foote J, Ehrisman J, et al. Associations between lymphovascular space invasion, nodal recurrence, and survival in patients with surgical stage I endometrioid endometrial adenocarcinoma. World J Surg Oncol 2019;17(1): 80.
39. Tortorella L, Restaino S, Zannoni GF, et al. Substantial lymph-vascular space invasion (LVSI) as predictor of distant relapse and poor prognosis in low-risk early-stage endometrial cancer. J Gynecol Oncol 2021; 32(2): e11.
40. Abu-Rustum N, Yashar C, Arend R, et al. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21(2): 181–209.
41. Matias-Guiu X, Selinger CI, Anderson L, et al. Data Set for the Reporting of Endometrial Cancer: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41(Suppl 1): 90–118.
42. Singh N, Hirschowitz L, Zaino R, et al. Pathologic Prognostic Factors in Endometrial Carcinoma (Other Than Tumor Type and Grade). Int J Gynecol Pathol 2019; 38 (Suppl 1): 93–113.
43. Cancer Protocol Templates. College of American Pathologists (cap.org). 2023. Dostupné z: https://www.cap.org.
44. Emons G, Steiner E, Vordermark D, et al. Endometrial Cancer. Guideline of the DGGG, DKG and DKH. Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures. Geburtshilfe Frauenheilkd 2023; 83 : 919–962.
45. Bosse T, Nout RA, McAlpine JN, et al. Molecular classification of grade 3 endometrioid endometrial cancers identifies distinct prognostic subgroups. Am J Surg Pathol 2018; 42(5): 561–568.
46. Bednaříková M, Hausnerová J, Minář L, et al. Molekulární testování karcinomu endometria – analýza prvních zkušeností z klinické praxe. Klin Onkol 2023; 36(3): 215–223.
47. Hejl Z, Hanáček J, Pilka R. Fertilitu zachovávající postupy u mladých žen s karcinomem endometria. Ceska Gynekol 2022; 87(3): 202 – 205.
48. Assem H, Rottmann D, Finkelstein A, et al. Minimal uterine serous carcinoma and endometrial polyp: a close clinicopathological relationship. Hum Pathol 2021; 118 : 1–8.
49. Dundr P. MONITOR aneb nemělo by vám uniknout, že... Cesk Patol 2022; 58(2): 72.
50. Michal M, Valha P, Velemínský M. Detekce sentinelové lymfatické uzliny u karcinomu endometria – porovnání účinnosti robotického a laparoskopického detekčního systému. Ceska Gynekol 2023;88(3):157–161.
51. Brych O, Drozenová J, Pichlík T, et al. Předoperační a pooperační staging u karcinomu endometria - prospektivní studie. Ceska Gynekol 2024; 89(1): 5–10.
52. Kayraklioglu N, Katsakhyan L, Cohen PA, et al. Perceptions of Controversies and Unresolved Issues in the 2014 FIGO Staging System for Endometrial Cancer: Survey Results From Members of the International Society of Gynecological Pathologists and International Gynecologic Cancer Society. Int J Gynecol Pathol 2024; 43 : 242–252.
53. Betella I, De Vitis LA, Calidona C, et al. Letter to the editor-The new FIGO staging system for endometrial cancer: Is the paradigm shift clinically feasible? Int J Gynaecol Obstet 2024; 164 : 364–365.
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