Department of Pneumonology, Oncology and Allergology, Medical University of Lublin, 20-090 Lublin, Poland.
II Department of Gynecology, Medical University of Lublin, 20-090 Lublin, Poland.
Int J Mol Sci. 2024 May 28;25(11):5893. doi: 10.3390/ijms25115893.
Endometrial cancer (EC) accounts for 90% of uterine cancer cases. It is considered not only one of the most common gynecological malignancies but also one of the most frequent cancers among women overall. Nowadays, the differentiation of EC subtypes is based on immunohistochemistry and molecular techniques. It is considered that patients' prognosis and the implementation of the appropriate treatment depend on the cancer subtype. Patients with pathogenic variants in have the most favorable outcome, while those with abnormal p53 protein have the poorest. Therefore, in patients with mutation, the de-escalation of postoperative treatment may be considered, and patients with abnormal p53 protein should be subjected to intensive adjuvant therapy. Patients with a DNA mismatch repair (dMMR) deficiency are classified in the intermediate prognosis group as EC patients without a specific molecular profile. Immunotherapy has been recognized as an effective treatment method in patients with advanced or recurrent EC with a mismatch deficiency. Thus, different adjuvant therapy approaches, including targeted therapy and immunotherapy, are being proposed depending on the EC subtype, and international guidelines, such as those published by ESMO and ESGO/ESTRO/ESP, include recommendations for performing the molecular classification of all EC cases. The decision about adjuvant therapy selection has to be based not only on clinical data and histological type and stage of cancer, but, following international recommendations, has to include EC molecular subtyping. This review describes how molecular classification could support more optimal therapeutic management in endometrial cancer patients.
子宫内膜癌（EC）占子宫癌病例的 90%。它不仅被认为是最常见的妇科恶性肿瘤之一，也是女性中最常见的癌症之一。如今，EC 亚型的区分基于免疫组织化学和分子技术。据认为，患者的预后和适当治疗的实施取决于癌症亚型。具有 种系变异的患者预后最佳，而 p53 蛋白异常的患者预后最差。因此，对于术后治疗的降级可能会在 突变的患者中被考虑，而异常 p53 蛋白的患者应接受强化辅助治疗。具有 DNA 错配修复（dMMR）缺陷的患者被归类为中间预后组，即无特定分子特征的 EC 患者。免疫疗法已被认为是具有错配缺陷的晚期或复发性 EC 患者的有效治疗方法。因此，根据 EC 亚型，提出了不同的辅助治疗方法，包括靶向治疗和免疫疗法，国际指南，如 ESMO 和 ESGO/ESTRO/ESP 发布的指南，包括对所有 EC 病例进行分子分类的建议。辅助治疗选择的决策不仅要基于临床数据和癌症的组织学类型和分期，还要根据国际建议，包括 EC 分子亚型。这篇综述描述了分子分类如何支持子宫内膜癌患者的更优化治疗管理。
