自2009年FIGO分期更新以来，关于子宫内膜癌的病理和分子特征的理解取得了很多进展。现在有更多关于几种组织学类型的结局和生物行为数据可用。自The Cancer Genome Atlas (TCGA)数据发布以来，分子和遗传学研究进展迅速，提供了对这一系列子宫内膜癌及其不同预后结果的多样生物本质的改善的明确认识。新分期系统的目标是更好地定义这些预后组，并创建能指示更适宜的手术、放射和全身治疗的亚分期。FIGO妇女癌委员会于2021年10月任命了一个关于子宫内膜癌分期的小组委员会，本文的作者担任成员。自那时以来，委员会成员频繁会议，并审查了有关子宫内膜癌的治疗、预后和生存的新证据和已有证据。基于这些数据，在每个四个阶段中确定了改善这些因素的分类和分层的机会。在最近制定的ESGO/ESTRO/ESP指南中进行的分子和组织学分类的数据和分析被用作向所提议的分子和组织学分期系统中添加新的亚分期的模板。根据现有证据，定义了以下亚分期：第I期（IA1）：限于息肉或被限制在子宫内的非侵袭性组织学类型的子宫内膜癌；（IA2）不侵袭性组织学类型的子宫内膜癌，涉及少于50%的子宫内膜，并且没有或仅有局灶性淋巴管内侵袭(LVSI)，按照WHO标准定义；（IA3）限于子宫的低分级子宫内膜腺癌，并有同时存在的低分级子宫内膜性卵巢受累；（IB）涉及50%或更多子宫内膜的非侵袭性组织学类型，并且没有LVSI或仅有局灶LVSI；（IC）侵袭性组织学类型，如漾泽细胞、高分级子宫内膜性腺癌、透明细胞癌、肉瘤样癌、未分化癌、混合型和其他不寻常类型，没有任何子宫肌层浸润。第II期（IIA）：浸润宫颈间质的非侵袭性组织学类型；（IIB）有明显LVSI的非侵袭性组织学类型；或（IIC）有任何子宫肌层浸润的侵袭性组织学类型。第III期（IIIA）：区分卵巢附属器和子宫浆膜浸润；（IIIB）阴道/子宫旁组织和盆腔腹膜转移；以及（IIIC）对盆腔和腹主动脉淋巴结转移的微转移和巨转移进行细化。第IV期（IVA）：侵犯膀胱或直肠粘膜的局部晚期疾病；（IVB）盆腹膜外转移；以及（IVC）远处转移。鼓励在所有子宫内膜癌中进行完整的分子分类（POLE突变、MMRd、NSMP、p53异常）。如果已知分子亚型，则通过添加表示分子分类的“m”和下标来记录在FIGO分期中。当分子分类揭示Stages I和II中的p53异常或POLE突变时，将导致疾病分期提高或降低（IICmp53异常或IAmPOLE突变）。更新的2023年子宫内膜癌分期包括多种组织学类型、肿瘤模式和分子分类，以更好地反映对多种类型的子宫内膜癌及其潜在生物行为的复杂理解的改进。在2023年分期系统中进行的变化应为治疗建议提供更具据依据的背景，并为更精细的未来结局和生存数据收集提供更好的环境。© 2023年亚洲妇科肿瘤学会、韩国妇科肿瘤学会和日本妇科肿瘤学会。

Many advances in the understanding of the pathologic and molecular features of endometrial cancer have occurred since the FIGO staging was last updated in 2009. Substantially more outcome and biological behavior data are now available regarding the several histological types. Molecular and genetic findings have accelerated since the publication of The Cancer Genome Atlas (TCGA) data and provide improved clarity on the diverse biological nature of this collection of endometrial cancers and their differing prognostic outcomes. The goals of the new staging system are to better define these prognostic groups and create substages that indicate more appropriate surgical, radiation, and systemic therapies.The FIGO Women's Cancer Committee appointed a Subcommittee on Endometrial Cancer Staging in October 2021, represented by the authors. Since then, the committee members have met frequently and reviewed new and established evidence on the treatment, prognosis, and survival of endometrial cancer. Based on these data, opportunities for improvements in the categorization and stratification of these factors were identified in each of the four stages. Data and analyses from the molecular and histological classifications performed and published in the recently developed ESGO/ESTRO/ESP guidelines were used as a template for adding the new subclassifications to the proposed molecular and histological staging system.Based on the existing evidence, the substages were defined as follows: Stage I (IA1): non-aggressive histological type of endometrial carcinoma limited to a polyp or confined to the endometrium; (IA2) non-aggressive histological types of endometrium involving less than 50% of the myometrium with no or focal lymphovascular space invasion (LVSI) as defined by WHO criteria; (IA3) low-grade endometrioid carcinomas limited to the uterus with simultaneous low-grade endometrioid ovarian involvement; (IB) non-aggressive histological types involving 50% or more of the myometrium with no LVSI or focal LVSI; (IC) aggressive histological types, i.e. serous, high-grade endometrioid, clear cell, carcinosarcomas, undifferentiated, mixed, and other unusual types without any myometrial invasion. Stage II (IIA): non-aggressive histological types that infiltrate the cervical stroma; (IIB) non-aggressive histological types that have substantial LVSI; or (IIC) aggressive histological types with any myometrial invasion. Stage III (IIIA): differentiating between adnexal versus uterine serosa infiltration; (IIIB) infiltration of vagina/parametria and pelvic peritoneal metastasis; and (IIIC) refinements for lymph node metastasis to pelvic and para-aortic lymph nodes, including micrometastasis and macrometastasis. Stage IV (IVA): locally advanced disease infiltrating the bladder or rectal mucosa; (IVB) extrapelvic peritoneal metastasis; and (IVC) distant metastasis. The performance of complete molecular classification (POLEmut, MMRd, NSMP, p53abn) is encouraged in all endometrial cancers. If the molecular subtype is known, this is recorded in the FIGO stage by the addition of "m" for molecular classification, and a subscript indicating the specific molecular subtype. When molecular classification reveals p53abn or POLEmut status in Stages I and II, this results in upstaging or downstaging of the disease (IICmp53abn or IAmPOLEmut).The updated 2023 staging of endometrial cancer includes the various histological types, tumor patterns, and molecular classification to better reflect the improved understanding of the complex nature of the several types of endometrial carcinoma and their underlying biologic behavior. The changes incorporated in the 2023 staging system should provide a more evidence-based context for treatment recommendations and for the more refined future collection of outcome and survival data.© 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.