Practical implications of the ESGO ESTRO ESP 2025 endometrial guidelines

Résumé fourni par la source

The treatment of Endometrial cancer has undergone radical changes in the recent past with regard to the revised International Federation of Gynaecology and Obstetrics (FIGO) endometrial staging (2023) and European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology (ESGO-ESTRO-ESP) adjuvant risk stratification(2025). There is a lacunae regarding the impact of these changes in the Low middle income countries(LMIC) compared to their predecessor models. a. To determine the percentage change in (i) the stage of patients with endometrial cancer from the FIGO 2009 endometrial staging to the FIGO 2023 endometrial staging system and (ii) the risk stratification of patients from the ESGO-ESTRO-ESP 2021 guidelines compared to the ESGO-ESTRO-ESP 2025 guidelines. b. To compare the prognostic implication of the 2025 ESGO-ESTRO-ESP endometrial risk stratification compared to the previous 2021 risk stratification in predicting 3-year recurrence free survival (RFS). A retrospective cohort study was conducted from 1st January 2017 to 31st December 2025 who underwent primary treatment for endometrial cancer at a single tertiary cancer centre. All the patients with endometrial cancer were staged according to the FIGO 2023 and FIGO 2009 staging system. Adjuvant risk categorization was done as per ESGO-ESTRO-ESP 2021 and 2025 guidelines. Follow up of patients was done to determine recurrence done every 3 months for first two years, 6 monthly for next three years and then yearly. A total of 206 patients were included in the study. Median follow of patients was 36 months. Non aggressive histology was seen in 62% of patients. Substantial Lymphovascular invasion (LVSI) was seen in 17% of patients. Twenty-six (34%) of FIGO 2009 Stage IA and 31 patients (55%) of FIGO 2009 Stage IB were upstaged whereas 10 (45%) of FIGO 2009 Stage IIIA were down staged to IA3. When patients were stratified for adjuvant risk categorization in the ESGO-ESTRO-ESP 2025 classification 19% (8/42) in the intermediate risk group and 37% (12/32) of the high intermediate risk (HIR) group would have received more radical adjuvant treatment whereas 12% (9/70) of high-risk group would have received less radical adjuvant treatment. Comprehensive molecular profiling was done in only 15 patients(7%) with 5 patients (30%) having need for more radical treatment due to p53mutation. Kaplan Meier curves showed significant recurrence free survival RFS curve for ESGO-ESTRO-ESP 2021 but not for the ESGO-ESTRO-ESP 2025 system. With the advent of the ESGO-ESTRO-ESP 2025 guidelines, the FIGO 2023 staging system has transitioned to the becoming the backbone for determining adjuvant treatment. Given the wide disparity in availability of molecular testing and heterogeneity of the HIR group based on the availability of molecular testing the new 2025 molecular based classification is “too much and too soon” especially for patients in Low middle income countries.

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