Siegenthaler F, Lindemann K, Epstein E, Rau T T, Nastic D, Ghaderi M, Rydberg F, Mueller M D, Carlson J, Imboden S
Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland.
Department of Gynecological Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Gynecol Oncol. 2022 May;165(2):230-238. doi: 10.1016/j.ygyno.2022.02.024. Epub 2022 Mar 8.
Despite its generally favorable prognosis at primary diagnosis, recurrence of endometrial cancer remains an important clinical challenge. The aim of this study was to analyze the value of molecular classification in recurrent endometrial cancer.
This study included patients with recurrent endometrial cancer who underwent primary surgical treatment between 2004 and 2015 at the Karolinska University Hospital, Sweden and the Bern University Hospital, Switzerland (KImBer cohort) with molecular classification of the primary tumor.
Out of 594 molecularly classified endometrial cancer patients, 101 patients experienced recurrence, consisting of 2 POLEmut, 33 MMRd, 30 p53abn, and 36 NSMP tumors. Mean age at recurrence was 71 years and mean follow-up was 54 months. Overall, median time to first recurrence was 16 months (95% CI 12-20); with the shortest median time in MMRd patients, with 13 months (95% CI 5-21). The pattern of recurrence was distinct among molecular subgroups: MMRd tumors experienced more locoregional, while p53abn cases showed more abdominal recurrences (P = .042). Median survival after recurrence was best for MMRd cases (43 months, 95% CI 11-76), compared to 39 months (95% CI 21-57) and 10 months (95% CI 7-13) for the NSMP and p53abn cases respectively (log-rank, P = .001).
Molecular classification is a significant indicator of survival after recurrence in endometrial cancer patients, and patterns of recurrence differ by molecular subgroups. While MMRd endometrial cancer show more locoregional recurrence and the best survival rates after recurrence, p53abn patients experience abdominal recurrence more often and had the worst prognosis of all recurrent patients.
尽管子宫内膜癌在初次诊断时总体预后良好，但复发仍是一项重要的临床挑战。本研究旨在分析分子分类在复发性子宫内膜癌中的价值。
本研究纳入了2004年至2015年间在瑞典卡罗林斯卡大学医院和瑞士伯尔尼大学医院接受初次手术治疗的复发性子宫内膜癌患者（KImBer队列），并对原发肿瘤进行了分子分类。
在594例经分子分类的子宫内膜癌患者中，101例出现复发，包括2例POLE突变型、33例错配修复缺陷（MMRd）型、30例p53异常型和36例非特异性分子谱（NSMP）型肿瘤。复发时的平均年龄为71岁，平均随访时间为54个月。总体而言，首次复发的中位时间为16个月（95%置信区间12 - 20）；MMRd患者的中位时间最短，为13个月（95%置信区间5 - 21）。分子亚组之间复发模式不同：MMRd肿瘤局部区域复发更多，而p53异常型病例腹部复发更多（P = 0.042）。复发后的中位生存期以MMRd病例最佳（43个月，95%置信区间11 - 76），相比之下，NSMP和p53异常型病例分别为39个月（95%置信区间21 - 57）和10个月（95%置信区间7 - 13）（对数秩检验，P = 0.001）。
分子分类是子宫内膜癌患者复发后生存的重要指标，且复发模式因分子亚组而异。虽然MMRd型子宫内膜癌局部区域复发更多且复发后生存率最佳，但p53异常型患者腹部复发更常见，且在所有复发患者中预后最差。
