2025年3月第56届美国妇科肿瘤学年会（SGO 2025）在美国西雅图隆重举办。作为全球妇科肿瘤领域的顶级盛会，SGO年会汇聚了众多业内顶级专家学者，共同探索最新的研究成果与技术革新。妇瘤医界聚焦领域前沿，分享在此次大会上展示的最新研究成果。
SGO 2025 前沿·聚焦
Implementation of FIGO 2023 staging may result in overtreatment of early-stage endometrial cancer
FIGO 2023分期的实施可能会导致早期子宫内膜癌的过度治疗
Allison Roy, et al.
Background 背景
The FIGO 2023 staging created new stages based on risk factors including LVSI, POLE and p53 classifications rather than anatomic structures. These risk factors have been shown to impact survival；however, they do not currently have specific treatment guidelines. Treatment of endometrial cancer based on published data cannot be easily extrapolated to the population of patients with early endometrial cancer who are upstaged by the FIGO 2023 system. This study aims to show what the potential impact of upstaging on treatment recommendations would be for patients with early endometrial cancer treated by the least and most aggressive regimens for their stage.
FIGO 2023分期基于包括LVSI、POLE和p53分类等风险因素，而非解剖结构，制定了新的分期。这些风险因素已被证明会影响生存率；然而，目前针对这些因素尚无具体的治疗指南。基于已发表的数据，子宫内膜癌的治疗不能轻易地推广到那些因FIGO 2023分期而被升级分期的早期子宫内膜癌患者。本研究旨在揭示，对于那些按照所在分期接受最保守和最积极治疗方案的早期子宫内膜癌患者，分期升级对治疗建议可能产生的潜在影响。
Methods 方法
The total estimated number of endometrial cancer cases for 2024 was collected from published NCI/SEER data. The number of patients in each FIGO 2023 stage was estimated by using the Schwameis et al study of 519 patients’ stage shifts. The number of patients at each new/old stage pair was extrapolated to the total estimated endometrial cancer cases. Phase III trials published between 2000-2024 addressing stage I and II endometrial cancer treatment were reviewed along with the NCCN guidelines to assign treatment options for each stage. Treatment recommendations for the new FIGO 2023 staging groups where no prior correlating stage existed were extrapolated from treatment for the closest numerical stage. The number of patients who would receive excess calculations were done for the least and most aggressive regimens.
从已发表的NCI/SEER数据中收集2024年子宫内膜癌病例的预计总数。通过参考Schwameis等人对519例患者分期变化的研究，估算基于FIGO 2023分期的各期患者数量。将每对新/旧分期的患者数量外推到子宫内膜癌的预计总病例数。回顾2000-2024年间发表的关于I期和II期子宫内膜癌治疗的III期临床试验，并结合NCCN指南为每个分期分配治疗方案。对于此前没有相关对应分期的新FIGO 2023分期组，其治疗建议则参照最接近数字分期的治疗方案进行推断。根据最保守和最积极的治疗方案，对将会接受过度治疗的患者数量进行了计算。
Results 结果
67,880 patients will be diagnosed with endometrial carcinoma in 2024 and approximately 57,834 will be confined to the uterus and cervix. Use of the 2023 FIGO staging system would result in upstaging an estimated 14,996 patients annually from 2009 Stage IA-II to 2023 Stage IC-IIC. Approximately 1700 patients would be down staged. All of which would be based on presence of POLE mutation. Using the most conservative treatment for the 2009 and 2023 stage resulted in excess treatment to 10,536 (15.5%) patients and the type of excess treatment was all external beam radiation (EBRT). Using the most aggressive treatment for the 2009 and 2023 stage resulted in excess EBRT treatment of 3,319 (4.9%) patients and excess chemotherapy given to up to 10,487 (15.4%) patients annually. The population of patients that was most affected by the upstaging were patients who had uterine confined disease with either extensive LVSI or p53 mutations. Patients with stage I and Il serous or clear cell histology were upstaged but the treatment recommendations remained unchanged except for the 49 patients who had negative washings and no invasion where observation could be considered under the 2009 stage.
2024年，67880名患者被诊断为子宫内膜癌，其中约57834名患者的病灶局限于子宫和宫颈。采用FIGO 2023分期系统，预计每年将有14996名患者从FIGO 2009 IA-II期升级至FIGO 2023 IC-IIC期。大约1700名患者的分期将会降级，所有降级均基于POLE基因突变的存在。按照2009和2023分期采用最保守的治疗方案，会导致10536名（15.5%）患者接受过度治疗，且过度治疗的类型均为EBRT。按照2009和2023分期采用最积极的治疗方案，每年会导致3319名（4.9%）患者接受过度的EBRT，以及每年最多10487名（15.4%）患者接受过度化疗。受分期升级影响最大的患者群体是那些病灶局限于子宫，且伴有广泛LVS或p53突变的患者。I期和II期浆液性或透明细胞组织学类型的患者分期被升级，但治疗建议基本保持不变，除49名患者外，这些患者为腹腔冲洗液阴性且无癌浸润，按照2009分期可考虑进行观察。
Conclusions 结论
The treatment of uterine-confined endometrial carcinomas based on 2023 staging alone may result in overtreatment which could result in excess morbidity. Using the 2023 FIGO staging, the same pathology would receive more aggressive treatment. Most often this would be in the form of excess EBRT. EBRT and chemo are associated with both short and long-term toxicity .Gynecologic Oncologists will need to use caution when applying treatment recommendations based on FIGO 2023 staging for patients with disease confined to the uterus and cervix.
仅基于2023分期标准对局限于子宫的子宫内膜癌进行治疗，可能会导致过度治疗，进而增加患者的发病率。使用FIGO 2023分期，相同的病理将会接受更积极的治疗，最常见的形式是过度EBRT。EBRT和化疗都存在短期和长期的毒性。妇科肿瘤医生在依据 FIGO 2023分期对于病灶局限于子宫和宫颈的患者制定治疗建议时需谨慎。
