Molecular genetic classification of endometrial cancer in the context of personalised medicine

The article presents a new classification of endometrial cancer developed by the International Federation of Gynecology and Obstetrics (FIGO): FIGO 2023. Literature search was performed in the PubMed, Medline, RSCI (Russian Science Citation Index) databases using key words “endometrial cancer”, “molecular genetic study”, “FIGO 2023”, “POLE gene mutations”, “dMMR status”, “ТР53 gene”, “NSMP”. In total, 206 articles were found (published between 1983 and 2024), the more significant articles (45) were included in this literature review. The renewed FIGO 2023 classification contains 19 endometrial cancer substages: 5 are included in stage I, 3 in stage II, 8 in stage III, 3 in stage IV. The main differences of the new classification from FIGO 2009 are the specification of tumor type (aggressive/non-aggressive), level of lymphovascular involvement, presence of macro- or micrometastases in the lymph nodes, as well as characteristics of molecular and genetic markers. According to the new FIGO 2023 classification, change of stage is recommended depending on the presence of mutations in the POLE and ТР53 genes. Thus, stage IA includes tumors with favorable prognosis and mutation in the POLE gene (stage IAmPOLEmut), stage IIC includes tumors with unfavorable prognosis and mutation in the ТР53 gene (stage IICmp53abn). According to the data of trials, the identified substages – which take into account molecular profile of the tumor – significantly differ in terms of oncological outcomes of disease progression.

Therefore, introduction of the new FIGO 2023 classification taking into account molecular biology features of the tumor will allow to adopt a more targeted approach to management of patients with endometrial cancer and to make predictions on disease progression. One of the remaining important questions is further study of long-term results of adjuvant therapy.

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