Zouzoulas Dimitrios, Tsolakidis Dimitrios, Sofianou Iliana, Tzitzis Panagiotis, Pervana Stavroula, Topalidou Maria, Timotheadou Eleni, Grimbizis Grigoris
1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
Anatomical Pathology Laboratory, Papageorgiou Hospital, Thessaloniki, Greece.
Cytojournal. 2024 Nov 21;21:47. doi: 10.25259/Cytojournal_37_2024. eCollection 2024.
The traditional histopathological analysis of endometrial cancer (EC) is the main risk group classification tool (low, intermediate, high-intermediate, and high) for the implementation of adjuvant treatment. The International Federation of Gynecology and Obstetrics staging system of EC has incorporated a new molecular classification that serves as a new triage tool for optimal treatment planning for these patients. Our study aimed to investigate the prognostic role of the new molecular classification in EC.
A prospective study was conducted in the 1 Department of Obstetrics and Gynecology from January 1, 2022, to March 30, 2024, and included all new EC cases that presented the multidisciplinary tumor (MDT) board after surgery. We considered the traditional pathologic analysis and new molecular classification after performing tests on microsatellite instability (MSI), DNA polymerase epsilon (POLE) mutation, and p53 immunohistochemistry testing.
The study included 65 patients with presumed early endometrial. All patients underwent surgery and subsequent molecular testing. Among the patients, 35 (54%) had a "positive" result in all of the three markers of molecular classification: 14 patients presented with MSI-H, 5 with POLE gene mutation, and 17 with p53 abnormal expression. One case of multiple classifiers was presented. After the integration of molecular classification, a change was observed in the final MDT board decision in 23 cases (35.4%), including six cases of overtreatment and 17 cases of undertreatment, with statistical significance ( = 0.03469).
The data suggest that the new molecular classification, that is, testing for POLE mutation, MSI, and p53 mutation and for endometrial carcinoma, is a valuable tool for the recurrence risk prognosis and improved planning of adjuvant treatment for EC.
子宫内膜癌（EC）的传统组织病理学分析是实施辅助治疗的主要风险组分类工具（低、中、高中和高）。EC的国际妇产科联合会分期系统纳入了一种新的分子分类，作为这些患者最佳治疗规划的新分流工具。我们的研究旨在调查新分子分类在EC中的预后作用。
于2022年1月1日至2024年3月30日在妇产科1进行了一项前瞻性研究，纳入了术后提交多学科肿瘤（MDT）委员会的所有新发EC病例。在对微卫星不稳定性（MSI）、DNA聚合酶ε（POLE）突变和p53免疫组化检测进行测试后，我们考虑了传统病理分析和新分子分类。
该研究纳入了65例疑似早期子宫内膜癌患者。所有患者均接受了手术及后续分子检测。在这些患者中，35例（54%）在分子分类的所有三个标志物中均呈“阳性”结果：14例为MSI-H，5例为POLE基因突变，17例为p53异常表达。出现1例多分类情况。整合分子分类后，23例（35.4%）的最终MDT委员会决策发生了变化，包括6例过度治疗和17例治疗不足，具有统计学意义（ = 0.03469）。
数据表明，新的分子分类，即检测POLE突变、MSI和p53突变用于子宫内膜癌，是EC复发风险预后和改进辅助治疗规划的有价值工具。
