Under FIGO 2023 staging of endometrial carcinoma, which new molecular subtype has been incorporated that determines stage assignment?

• A MMR-deficient tumors that require Stage IIIC for all N0 disease
• B p53-abnormal (TCGA copy-number high) tumors staged as Stage II when confined to uterus
• C No molecular subtypes are incorporated in FIGO 2023 staging
• D POLE-mutated (ultramutated) tumors, which are now assigned Stage I regardless of grade or myometrial invasion ✓

Explanation

The FIGO 2023 endometrial carcinoma staging (published 2023) integrates molecular subtyping from the TCGA. POLE-mutated (ultramutated) tumors have an excellent prognosis and are classified as Stage IA(m)POLE regardless of histological grade or depth of invasion, reflecting their favorable biology. p53-abnormal tumors (serous-like biology) are classified as Stage IIC when confined to the uterus with high-grade histology. MMR-deficient tumors have intermediate prognosis. This molecular integration is a key advance in the 2023 revision.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.