早期子宫内膜癌2023年国际妇产科联盟新分期的应用与验证  

Application and verification of the International Federation of Gynecology and Obstetrics 2023 staging in early-stage endometrial cancer:a retrospective study

作　　者：卢云 郝圆圆 脱淑梅 王玥元 赵洁 Lu Yun;Hao Yuanyuan;Tuo Shumei(Department of Gynecologic Oncology,Gansu Provincial Maternity and Child-care Hospital(Gansu Provincial Central Hospital),Lanzhou 730050)

机构地区：[1]甘肃省妇幼妇幼保健院(甘肃省中心医院)妇科肿瘤科,兰州730050 [2]甘肃省妇幼妇幼保健院(甘肃省中心医院)病理科,兰州730050

出　　处：《现代妇产科进展》2025年第3期178-184,共7页Progress in Obstetrics and Gynecology

基　　金：兰州市科技计划项目(No:22-5-88)。

摘　　要：目的:在早期子宫内膜癌中应用FIGO 2023分期,探索其与2009分期的变化,比较不同分期标准及2021年欧洲妇科肿瘤学会(ESGO)风险分层在判断预后中的价值。方法:回顾性纳入接受手术治疗的Ⅰ~Ⅱ期(FIGO 2009)子宫内膜癌患者,根据分子分型结果和病理特征进行FIGO 2023再分期和ESGO风险分层,计算患者的生存率,比较不同分期的赤池信息量准则(AIC)值和一致性指数(C-index)。AIC值越小,C-index越高,预测准确性越高。结果:共纳入281例患者,应用FIGO 2023分期后共48例(17.1%)出现分期(包括亚分期)升级。根据分子分型修正分期后,9例(3.2%)因POLE突变型发生分期降级,7例(2.4%)因p53异常型而发生分期升级。Ⅰ期患者的FIGO 2023m分期的5年无复发生存RFS(96.8%)高于2009分期(91.6%),Ⅱ期患者5年RFS(64.9%)低于2009分期(85.7%)。FIGO 2023m分期的AIC值最小,C-index最高,具有最高的预后区分能力和准确性。结论:纳入分子分型的FIGO 2023分期是良好的生存预测因素,具有更高的预后区分能力。Objective:To explore the changes of the staging in early stage endometrial cancer by using FIGO 2023 and FIGO 2009 staging system,and to compare the prognosis predictive value of different staging system and 2021 European Society of Gynecological Oncology(ESGO)risk group.Methods:Patients with stageⅠ~Ⅱendometrial cancer who underwent surgical treatment were retrospectively enrolled,and FIGO 2023 restaging was performed based on molecular classification and pathologic features.The survival rate of the patients was calculated,and the Akaike information criterion(AIC)values and Harrell's concordance index(C-index)were compared.A higher C-index score and a lower AIC value indicated a more accurate model.Results:A total of 281 patients were included,and 48 cases(17.1%)showed upgrade in stage(including sub-stage)after applying FIGO 2023 staging.After correction of staging according to molecular typing,9 cases(3.2%)showed stage downgrade due to POLE mutant subtype,and 7 cases(2.4%)upshifted due to p53 aberrant subtype.5-year relapse-free survival(RFS)in stageⅠpatients was higher in FIGO 2023m staging(96.8%)than in 2009 staging(91.6%),and 5-year RFS in stageⅡpatients was lower in FIGO 2023m staging(64.9%)than those in 2009 staging(85.7%).FIGO 2023m staging had the discriminatory ability and accuracy with the low AIC value and the high C-index.Conclusion:FIGO 2023 staging with molecular classification is a good predictor of survival with higher prognostic discriminatory ability.

关 键 词：子宫内膜癌 国际妇产科联盟分期 分子分型 预后 

分 类 号：R737.33[医药卫生—肿瘤]