ESGO/ESTRO/ESP 2021 Endometrial Risk Groups: Molecular Classification Unknown

Identity and version lock

The ESGO/ESTRO/ESP 2021 Endometrial Risk Groups interpreter implements the clinicopathologic table for cases in which molecular classification is unknown or unavailable. It uses externally assigned FIGO 2009 stage and final postoperative pathology.

This is not ESMO, not a FIGO 2023 classifier, and not the 2025 ESGO/ESTRO/ESP update. Keeping those frameworks separate prevents stage-version and molecular-pathway hybridization.

Required pathology

The source table uses stage, histologic type, grouped FIGO grade, LVSI extent, myometrial invasion, and residual disease. The interpreter requires all six fields for an otherwise applicable case. It does not derive them from free text or imaging.

Grade 1-2 is represented as low grade and grade 3 as high grade. LVSI must be externally reported as negative, focal, or substantial. Stage IB with absent myometrial invasion is rejected as contradictory.

What the result means

The output is one of the source-defined prognostic groups: low, intermediate, high-intermediate, high, or advanced/metastatic. Some structurally valid states, including stage I-II with residual disease, are withheld as not classifiable from this table rather than forced into a category.

The result is a historical prognostic-group interpretation. It does not prescribe treatment, calculate recurrence or survival probability, or substitute for current multidisciplinary review.

Scope boundaries

The interpreter is limited to adults with primary endometrial carcinoma, final postoperative pathology, FIGO 2009 staging, and unavailable or unknown molecular classification. Known molecular classification, another staging edition, preoperative or incomplete assessment, and recurrent-disease restaging are outside this route.

Related tool: gestational trophoblastic neoplasia

FIGO-Modified WHO GTN Risk Score 2026 is a separate gestational trophoblastic neoplasia tool. It is not part of the ESGO/ESTRO/ESP endometrial framework described on this page.

Verification

The implementation was checked against a separately encoded literal decision-table oracle across every combination of six histologies, nine stages, grade, LVSI, invasion, and residual disease. This is software implementation verification, not prospective clinical validation.

Sources

1. Concin N, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31:12-39. DOI 10.1136/ijgc-2020-002230.
2. Full 2021 guideline PDF.
3. ESGO endometrial cancer pocket guideline.