2023版子宫内膜癌FIGO分期更新对病理诊断内容的影响

doi:10.12280/gjfckx.20240166

摘要/Abstract

摘要：

子宫内膜癌是女性生殖系统最常见的恶性肿瘤，近年来子宫内膜癌诊疗中备受关注的热点问题，如淋巴脉管间隙浸润的定量评价、前哨淋巴结超分期和子宫内膜癌分子分型等，已经逐渐用于临床实践。目前，子宫内膜癌相关的新进展已被写入2023版国际妇产科联盟（International Federation of Gynecology and Obstetrics，FIGO）子宫内膜癌分期修订版本，并在临床推广应用。规范的病理诊断是评估子宫内膜癌患者预后和指导辅助治疗的重要依据，介绍2023版FIGO子宫内膜癌分期更新对病理诊断内容的影响，旨在帮助提高病理医生子宫内膜癌病理诊断的规范化及标准化水平，辅助临床医生更准确地理解和应用新分期。

关键词: 子宫内膜肿瘤, 肿瘤浸润, 淋巴转移, 前哨淋巴结, 分子分类, 国际妇产科联盟

Abstract:

Endometrial carcinoma is the most common malignancy of the female reproductive system. Recent years have witnessed pivotal developments in the diagnosis and treatment, including the quantitative assessment of lymphovascular space invasion, the ultrastaging of sentinel lymph nodes, and the molecular stratification of endometrial carcinoma, all progressively integrated into clinical practice. These new insights have been incorporated into the 2023 version of the staging system by the International Federation of Gynecology and Obstetrics (FIGO), heralding a new era of clinical adoption. The importance of precise pathological evaluation cannot be overstated, serving as a linchpin for prognosticating patient outcomes and steering the course of adjuvant therapies. Through the lens of the updated 2023 FIGO staging for endometrial carcinoma, this discourse aims to elevate the paradigm of pathological diagnosis, promoting a benchmark of standardization and precision for pathologists, thereby empowering clinicians with a deeper and more accurate application of the staging system.

Key words: Endometrial neoplasms, Neoplasm invasiveness, Lymphatic metastasis, Sentinel lymph node, Molecular typing, International Federation of Gynecology and Obstetrics

司婧文, 于秀杰, 申彦. 2023版子宫内膜癌FIGO分期更新对病理诊断内容的影响[J]. 国际妇产科学杂志, 2024, 51(3): 241-246.

SI Jing-wen, YU Xiu-jie, SHEN Yan. The Impact of the 2023 FIGO Staging Update of Endometrial Carcinoma on the Content of Pathological Diagnosis[J]. Journal of International Obstetrics and Gynecology, 2024, 51(3): 241-246.

图/表 2

参考文献 29

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分期	2023版FIGO分期^[2]	2009版FIGO分期^[5]
Ⅰ期	肿瘤局限于子宫体和卵巢	肿瘤局限于子宫
ⅠA	肿瘤局限于子宫内膜，或非侵袭性组织学亚型（低级别子宫内膜样癌）侵犯肌层<1/2，无或局灶性LVSI，或预后良好	肿瘤局限于子宫内膜或侵犯肌层<1/2
	ⅠA1：非侵袭性组织学亚型局限于子宫内膜息肉，或局限于子宫内膜
	ⅠA2：非侵袭性组织学亚型侵犯肌层<1/2，无或局灶性LVSI
	ⅠA3：同时存在局限于子宫和卵巢的低级别子宫内膜样癌
ⅠB	非侵袭性组织学亚型侵犯肌层≥1/2，无或局灶性LVSI	肿瘤侵犯肌层≥1/2
ⅠC	侵袭性组织学亚型局限于息肉，或局限于子宫内膜
Ⅱ期	肿瘤侵犯宫颈间质但无子宫体外扩散，或大量LVSI，或侵袭性组织学亚型侵犯子宫肌层	肿瘤侵犯宫颈间质但仍局限于子宫
ⅡA	非侵袭性组织学亚型侵犯宫颈间质
ⅡB	非侵袭性组织学亚型伴大量LVSI
ⅡC	侵袭性组织学亚型侵犯子宫肌层
Ⅲ期	任何组织类型伴局部或区域性扩散	肿瘤局部或区域性扩散
ⅢA	肿瘤累及子宫浆膜面和（或）附件，直接扩散或转移	肿瘤累及子宫浆膜面和（或）附件
	ⅢA1：扩散至卵巢或输卵管（符合ⅠA3期标准的除外）
	ⅢA2：肿瘤侵犯子宫浆膜或通过子宫浆膜向外扩散
ⅢB	肿瘤转移或直接蔓延到阴道和（或）宫旁，或转移到盆腔腹膜	肿瘤累及阴道和（或）宫旁
	ⅢB1：肿瘤转移或直接蔓延到阴道和（或）宫旁
	ⅢB2：肿瘤转移到盆腔腹膜
ⅢC	肿瘤转移至盆腔和（或）腹主动脉旁淋巴结	肿瘤转移至盆腔和（或）腹主动脉旁淋巴结
	ⅢC1：转移到盆腔淋巴结	盆腔淋巴结阳性
	ⅢC1i：微转移（转移灶直径0.2~2.0 mm）
	ⅢC1ii：宏转移（转移灶直径>2.0 mm）
	ⅢC2：转移至肾血管下方的腹主动脉旁淋巴结，有或无盆腔淋巴结转移	腹主动脉旁淋巴结阳性和（或）盆腔淋巴结阳性
	ⅢC2i：微转移（转移灶直径0.2~2.0 mm）
	ⅢC2ii：宏转移（转移灶直径>2.0 mm）
Ⅳ期	肿瘤侵犯膀胱黏膜和（或）肠黏膜和（或）远处转移	肿瘤侵犯膀胱和（或）侵犯直肠黏膜和（或）远处转移
ⅣA	肿瘤侵犯膀胱和（或）侵犯肠黏膜	肿瘤侵犯膀胱和（或）侵犯直肠黏膜
ⅣB	肿瘤转移到盆腔外腹腔腹膜	远处转移，包括腹腔内转移和腹股沟淋巴结转移
ⅣC	远处转移，包括转移到肾血管上方的任何腹腔外或腹腔内的淋巴结、肺、肝、脑或骨转移

分期	2023版FIGO分期^[2]	2009版FIGO分期^[5]
Ⅰ期	肿瘤局限于子宫体和卵巢	肿瘤局限于子宫
ⅠA	肿瘤局限于子宫内膜，或非侵袭性组织学亚型（低级别子宫内膜样癌）侵犯肌层<1/2，无或局灶性LVSI，或预后良好	肿瘤局限于子宫内膜或侵犯肌层<1/2
	ⅠA1：非侵袭性组织学亚型局限于子宫内膜息肉，或局限于子宫内膜
	ⅠA2：非侵袭性组织学亚型侵犯肌层<1/2，无或局灶性LVSI
	ⅠA3：同时存在局限于子宫和卵巢的低级别子宫内膜样癌
ⅠB	非侵袭性组织学亚型侵犯肌层≥1/2，无或局灶性LVSI	肿瘤侵犯肌层≥1/2
ⅠC	侵袭性组织学亚型局限于息肉，或局限于子宫内膜
Ⅱ期	肿瘤侵犯宫颈间质但无子宫体外扩散，或大量LVSI，或侵袭性组织学亚型侵犯子宫肌层	肿瘤侵犯宫颈间质但仍局限于子宫
ⅡA	非侵袭性组织学亚型侵犯宫颈间质
ⅡB	非侵袭性组织学亚型伴大量LVSI
ⅡC	侵袭性组织学亚型侵犯子宫肌层
Ⅲ期	任何组织类型伴局部或区域性扩散	肿瘤局部或区域性扩散
ⅢA	肿瘤累及子宫浆膜面和（或）附件，直接扩散或转移	肿瘤累及子宫浆膜面和（或）附件
	ⅢA1：扩散至卵巢或输卵管（符合ⅠA3期标准的除外）
	ⅢA2：肿瘤侵犯子宫浆膜或通过子宫浆膜向外扩散
ⅢB	肿瘤转移或直接蔓延到阴道和（或）宫旁，或转移到盆腔腹膜	肿瘤累及阴道和（或）宫旁
	ⅢB1：肿瘤转移或直接蔓延到阴道和（或）宫旁
	ⅢB2：肿瘤转移到盆腔腹膜
ⅢC	肿瘤转移至盆腔和（或）腹主动脉旁淋巴结	肿瘤转移至盆腔和（或）腹主动脉旁淋巴结
	ⅢC1：转移到盆腔淋巴结	盆腔淋巴结阳性
	ⅢC1i：微转移（转移灶直径0.2~2.0 mm）
	ⅢC1ii：宏转移（转移灶直径>2.0 mm）
	ⅢC2：转移至肾血管下方的腹主动脉旁淋巴结，有或无盆腔淋巴结转移	腹主动脉旁淋巴结阳性和（或）盆腔淋巴结阳性
	ⅢC2i：微转移（转移灶直径0.2~2.0 mm）
	ⅢC2ii：宏转移（转移灶直径>2.0 mm）
Ⅳ期	肿瘤侵犯膀胱黏膜和（或）肠黏膜和（或）远处转移	肿瘤侵犯膀胱和（或）侵犯直肠黏膜和（或）远处转移
ⅣA	肿瘤侵犯膀胱和（或）侵犯肠黏膜	肿瘤侵犯膀胱和（或）侵犯直肠黏膜
ⅣB	肿瘤转移到盆腔外腹腔腹膜	远处转移，包括腹腔内转移和腹股沟淋巴结转移
ⅣC	远处转移，包括转移到肾血管上方的任何腹腔外或腹腔内的淋巴结、肺、肝、脑或骨转移

操作出处	取材方式	切片间隔厚度（μm）	水平面数量（个）	每水平面切片张数
MD Anderson Cancer Center^[14]	间隔2 mm，垂直于长轴方向取材	250	5	3张（1张HE+2张未染色）
MSKCC^[15]		50	2	2张（1张HE+1张未染色）
ESP指南^[16]		200	5	1张HE，至少2个水平附加1张未染色切片行免疫组织化学检查
中国共识^[13]		50	2	2张（1张HE+1张未染色）

操作出处	取材方式	切片间隔厚度（μm）	水平面数量（个）	每水平面切片张数
MD Anderson Cancer Center^[14]	间隔2 mm，垂直于长轴方向取材	250	5	3张（1张HE+2张未染色）
MSKCC^[15]		50	2	2张（1张HE+1张未染色）
ESP指南^[16]		200	5	1张HE，至少2个水平附加1张未染色切片行免疫组织化学检查
中国共识^[13]		50	2	2张（1张HE+1张未染色）