Clinical Implications of Incorporating Molecular Profiles into the Staging of Endometrial Cancer: A Critical Review of the 2023 FIGO System on the Wave of 2025 ESGO/ESTRO/ESP Guidelines

Abstract

Simple Summary The present paper reviews the 2023 FIGO staging system for endometrial cancer, which for the first time incorporates molecular testing (like POLE mutations and p53 status) alongside traditional anatomical findings. This update reflects tumor biology and helps avoid over- or under-treating patients, though it also introduces some practical challenges. Access to molecular testing varies widely, so a patient’s cancer stage can depend partly on where they are treated, not just their tumor’s biology. Staging can also change after surgery once molecular results come back, which requires clear communication with patients. The paper also discusses inconsistent grouping of aggressive cancer subtypes and variability in measuring lymphovascular invasion as areas needing further standardization. We therefore propose that anatomical stage remain fixed and universal, while molecular and pathological findings guide a separate risk-stratification system for treatment planning, keeping staging simple and consistent worldwide while still enabling personalized care.