De Vitis Luigi A, Reyes-Baez Fiorella E, Schivardi Gabriella, Shahi Maryam, Fought Angela J, McGree Michaela E, Capasso Ilaria, Grcevich Leah, Betella Ilaria, Ghioni Mariacristina, Guerini-Rocco Elena, Aletti Giovanni D, Cliby William, Multinu Francesco, Langstraat Carrie L, Mariani Andrea, Glaser Gretchen E
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA.
Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA; Department of Gynecology, European Institute of Oncology (IEO), IRCCS, Milan, Italy.
Gynecol Oncol. 2025 Feb;193:81-88. doi: 10.1016/j.ygyno.2024.12.013. Epub 2025 Jan 10.
The optimal treatment for patients with cervical stromal invasion (CSI) in endometrial cancer (EC) remains unclear. We aimed to test the prognostic role of molecular classification in EC patients with CSI.
A retrospective, multicenter review of EC patients with CSI was performed. EC cases were assigned to one of the molecular classes: POLE mutated (POLEmut), MMR deficient (MMRd), p53 abnormal (p53abn), or no specific molecular profile (NSMP). Three-year recurrence-free survival (RFS) from surgery was estimated using the Kaplan-Meier method. Cox proportional hazards regression models were fit to adjust for confounders.
Overall, 162 EC patients with CSI were identified: 70 (43.2 %) NSMP, 49 (30.2 %) p53abn, 40 (24.7 %) MMRd, 3 (1.9 %) POLEmut. POLEmut cases were excluded from further analysis, because of the small number of patients identified. At univariate analysis, molecular class was significantly associated with recurrence within 3 years after surgery (p = 0.04). Three-year RFS was 59.9 % (95 % confidence interval [CI], 46.1-77.8 %) for NSMP, 50.6 % (95 % CI, 34.9-73.2 %) for MMRd, and 33.1 % (95 % CI, 19.7-55.3 %) for p53abn. After adjusting for stage and grade, molecular class was no longer significantly associated with recurrence within three years (p = 0.28).
Traditional risk factors such as grade and stage remain critical in determining the prognosis of endometrial cancer with cervical stromal invasion. This study highlights the importance of integrating both molecular and morphological features in determining the prognosis of endometrial cancer, with particular emphasis on endometrioid histotypes.
子宫内膜癌（EC）宫颈间质浸润（CSI）患者的最佳治疗方案仍不明确。我们旨在测试分子分类在EC合并CSI患者中的预后作用。
对EC合并CSI患者进行了一项回顾性多中心研究。EC病例被分为以下分子类别之一：POLE突变型（POLEmut）、错配修复缺陷型（MMRd）、p53异常型（p53abn）或无特定分子特征型（NSMP）。采用Kaplan-Meier法估计术后三年无复发生存率（RFS）。采用Cox比例风险回归模型对混杂因素进行校正。
总体而言，共确定了162例EC合并CSI患者：70例（43.2%）为NSMP，49例（30.2%）为p53abn，40例（24.7%）为MMRd，3例（1.9%）为POLEmut。由于POLEmut病例数量较少，因此被排除在进一步分析之外。单因素分析显示，分子类别与术后3年内复发显著相关（p = 0.04）。NSMP患者的三年RFS为59.9%（95%置信区间[CI]，46.1-77.8%），MMRd患者为50.6%（95% CI，34.9-73.2%），p53abn患者为33.1%（95% CI，19.7-55.3%）。在对分期和分级进行校正后，分子类别与三年内复发不再显著相关（p = 0.28）。
分级和分期等传统危险因素在确定宫颈间质浸润性子宫内膜癌的预后方面仍然至关重要。本研究强调了在确定子宫内膜癌预后时整合分子和形态学特征的重要性，尤其侧重于子宫内膜样组织学类型。
