Annual hazard rates for early-stage endometrial carcinoma after postoperative radiotherapy under FIGO 2023 staging system: results from a population-based single-center cohort study

Objective: To investigate whether early-stage endometrial carcinoma (EC) patients have survival outcomes comparable to those of the general population, and further explore the dynamic recurrence/death surveillance value of International Federation of Gynecology and Obstetrics (FIGO) 2023 staging system.Methods: This retrospective study analyzed FIGO 2009 stage I-II patients receiving postoperative radiotherapy at Peking Union Medical College Hospital in China (2000China ( -2020)), re-staged per FIGO 2023 staging system.Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier methods; mortality was compared to age-/sex-matched Chinese controls using standardized mortality ratios (SMRs); recurrence/death trajectories were modeled through annual hazard rates; FIGO 2023 recurrence prediction accuracy was assessed via receiver operating characteristics analysis.Results: This study of 1222 EC patients revealed upstaging from FIGO 2009 to 2023 (IAII: 27.2%; IBII: 26.4%).OS rates were 97.7% (3-year), 94.9% (5-year), and 91.0%(10-year), with corresponding DFS rates of 93.4%, 87.4%, and 82.8%.Under FIGO 2023 staging system, recurrence risk peaked at 1.3 years (3.5%) and declined after 3 years.Mortality risk increased within 4 years, stabilizing at about 1.0% thereafter.IC/IIC stages showed the earliest/highest risk peaks.Stage IA1-IA2 required monitoring for late recurrences (>3 years), while IIC needed vigilance for delayed mortality (>3 years).FIGO 2023 staging system was an independent prognostic factor for recurrence prediction (area under the curve: 1-year=0.644;3-year=0.612;5-year=0.611).Conclusion: Early-stage EC patients had favorable prognosis.