The 2023 FIGO Stage IA3: shifting the SEOC paradigm from pathogenic debate to clinical precision

This binary separation is crucial.It prevents the dangerous underestimation of tumors that appear morphologically similar but possess aggressive or advanced features, such as substantial lymph vascular space invasion, deep myometrial invasion, non-endometrioid histology, or bilateral ovarian involvement, which definitively exclude a case from Stage IA3 and mandate upstaging to IIIA1.Furthermore, the alignment of Stage IA3 with the 2025 European Society of Gynaecological Oncology-European Society for Radiotherapy and Oncology-European Society of Pathology guidelines provides a coherent roadmap: Stage IA3 patients may safely spare adjuvant chemotherapy, whereas those upstaged to IIIA1 (due to exclusion from IA3) are mandated for systemic treatment [15].This ends the era where "2 low-risk cancers" were managed solely based on subjective interpretation.In conclusion, the FIGO 2023 Stage IA3 is not merely a new label; it is a critical risk-stratification tool.It validates the "favorable prognosis" of a specific SEOC subset while ensuring that patients with true high-risk metastatic features are not undertreated.We urge clinicians to utilize the Stage IA3 criteria strictly-not just to identify who can avoid chemotherapy, but to identify who cannot.