Tresa Anila, Sambasivan Suchetha, Rema P, Dinesh Dhanya, Sivaranjith J, Nair Sindhu P, Mathew Aleyamma, Ammu J V, Kumar Aswin
Division of Gynecological Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India.
Division of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala India.
Indian J Surg Oncol. 2022 Sep;13(3):580-586. doi: 10.1007/s13193-022-01523-9. Epub 2022 Mar 3.
Clinicopathologic classification of endometrial cancer imperfectly reflects the tumor biology. Pathologic categorization - especially in high-grade tumors - results in an imprecise estimation of the risk of disease, recurrence, and death. Molecular subtyping is emerging as the standard of care in diagnosis and treatment of endometrial cancers. Molecular markers are important prognostic factors in tumor dissemination and early recurrence of endometrial cancers. TP53 mutation is an important prognostic factor for both serous and endometrioid cancers. The study aims to compare the clinical profile and overall survival of endometrial cancers with and without p53 mutation. Sixty-three patients who underwent surgical staging for carcinoma endometrium were included in the study.TP53 mutation status was determined based on p53 expression by immunohistochemistry (IHC) as a p53 wild or p53 mutant type. Data were analyzed for the clinical profile, p53 mutation status on IHC, histological pattern, tumor grade, stage of the disease, lymph node spread, recurrence pattern, treatment received, 2-year disease-free survival, and overall survival. Recurrence was noted in 12.7% patients after 2-year follow-up, of which 75% patients had p53 mutation. Significant association was seen between p53 expression and high-grade tumors, stage, cervical involvement, and adnexal involvement. The 2-year overall survival of the p53 wild type was 97.2% and the p53 mutant type was 91.7%. The 2-year disease-free survival for the p53 wild type was 94.3% and the disease-free survival of the p53 mutant variety was 83.5%. The 2-year disease-free survival for endometrioid carcinoma with p53 wild type was 100% and p53 mutant variety was 86.2% ( value 0.033). About 15.9% (10) patients were reassigned to the high-risk group needing chemotherapy and radiation according to the ESGO ESTRO 2021 consensus classification, due to their p53 mutation status. IHC to assess somatic p53 mutation may be done in endometrial biopsies irrespective of their histology. This may help to identify that the aggressive tumors thereby help in tailoring surgery, planning adjuvant treatment, and follow-up.
子宫内膜癌的临床病理分类并不能完美地反映肿瘤生物学特性。病理分类——尤其是在高级别肿瘤中——会导致对疾病风险、复发和死亡风险的估计不准确。分子亚型分类正逐渐成为子宫内膜癌诊断和治疗的标准。分子标志物是子宫内膜癌肿瘤播散和早期复发的重要预后因素。TP53突变是浆液性癌和子宫内膜样癌的重要预后因素。本研究旨在比较有和没有p53突变的子宫内膜癌的临床特征和总生存期。63例行子宫内膜癌手术分期的患者纳入本研究。根据免疫组织化学(IHC)检测的p53表达情况确定TP53突变状态,分为p53野生型或p53突变型。分析了临床特征、IHC检测的p53突变状态、组织学类型、肿瘤分级、疾病分期、淋巴结转移、复发模式、接受的治疗、2年无病生存期和总生存期。2年随访后12.7%的患者出现复发,其中75%的患者有p53突变。p53表达与高级别肿瘤、分期、宫颈受累和附件受累之间存在显著关联。p53野生型的2年总生存率为97.2%,p53突变型为91.7%。p53野生型的2年无病生存率为94.3%,p53突变型的无病生存率为83.5%。p53野生型子宫内膜样癌的2年无病生存率为100%,p53突变型为86.2%(P值0.033)。根据ESGO ESTRO 2021共识分类,约15.9%(10例)患者因其p53突变状态被重新归类为需要化疗和放疗的高危组。无论组织学类型如何,均可在子宫内膜活检中通过IHC评估体细胞p53突变。这可能有助于识别侵袭性肿瘤,从而有助于制定手术方案、规划辅助治疗和随访。