Zhu Danqing, Shi Keyi, Hu Dongxiao, Lin Wanrun, Zhang Xiaofei, Zhou Feng, Li Yang
Department of Gynecologic Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Department of Gynecology, Fuyang Women and Children's Hospital, Hangzhou, Zhejiang Province, China, 311400.
J Cancer. 2025 Mar 31;16(7):2312-2320. doi: 10.7150/jca.108685. eCollection 2025.
Molecular classification has become an essential tool in endometrial carcinoma; however, its application in non-endometrioid carcinoma (NEEC), particularly rare histological subtypes, remains relatively unexplored. This study aims to investigate the potential utility of molecular classification in NEEC. : A retrospective analysis was conducted on 167 NEEC cases diagnosed at the Women's Hospital of Zhejiang University from 2013 to 2020. The cases were categorized into four molecular subtypes: ultra-mutated (mut), mismatch repair-deficient (MMRd), p53-abnormal (p53abn), and no specific molecular profile (NSMP) molecular subgroups Statistical significance was set at <0.05. Among the cases, 13 (7.8%) patients were classified as mut, 25 (15.0%) as MMRd, 84 (50.3%) as p53abn, and 45 (27.0%) as NSMP. Most mut cases were at early stages (11/13, 84.6% at stages I-II), whereas p53abn cases were predominantly at advanced stages (32/49, 65.3% at stages III-IV). Additionally, p53abn was the most common subtype in serous carcinoma (41/45, 91.1%) and mixed adenocarcinoma (24/57, 42.1%). The 3-year recurrence-free survival (RFS) rates for mut, MMRd, NSMP, and p53abn were 100.0%, 88.0%, 73.3%, and 71.4% , respectively. The 3-year overall survival (OS) rates were 100.0%, 88.0%, 82.2%, and 73.8%, respectively. Univariate analysis revealed significant associations of age ≥60 years (=0.01), hypertension (=0.03), FIGO stage (<0.001), lymphovascular space invasion (=0.01), lymph node metastasis (<0.001), myometrial invasion (<0.001), and postoperative adjuvant therapy (=0.01) with 3-year RFS. Multivariate analysis identified age ≥60 years (=0.03), myometrial invasion (=0.01), and FIGO stage (=0.046) as independent risk factors for 3-year OS. Molecular classification is crucial for accurately predicting the prognosis of NEEC, enabling more tailored treatment approaches in clinical practice. Furthermore, patient age may have a significant influence on NEEC classification and progression.
分子分类已成为子宫内膜癌诊断中的一项重要工具；然而，其在非子宫内膜样癌（NEEC），尤其是罕见组织学亚型中的应用仍相对缺乏探索。本研究旨在探讨分子分类在NEEC中的潜在应用价值。对2013年至2020年在浙江大学医学院附属妇产科医院确诊的167例NEEC病例进行回顾性分析。这些病例被分为四种分子亚型：超突变型（mut）、错配修复缺陷型（MMRd）、p53异常型（p53abn）和无特定分子特征型（NSMP）分子亚组。设定统计学显著性水平为<0.05。在这些病例中，13例（7.8%）患者被分类为mut型，25例（15.0%）为MMRd型，84例（50.3%）为p53abn型，45例（27.0%）为NSMP型。大多数mut型病例处于早期阶段（13例中的11例，84.6%处于I-II期），而p53abn型病例主要处于晚期阶段（49例中的32例，65.3%处于III-IV期）。此外，p53abn是浆液性癌（45例中的41例，91.1%）和混合性腺癌（57例中的24例，42.1%）中最常见的亚型。mut型、MMRd型、NSMP型和p53abn型的3年无复发生存率（RFS）分别为100.0%、88.0%、73.3%和71.4%。3年总生存率（OS）分别为100.0%、88.0%、82.2%和73.8%。单因素分析显示年龄≥60岁（=0.01）、高血压（=0.03）、国际妇产科联盟（FIGO）分期（<0.001）、淋巴血管间隙浸润（=0.01）、淋巴结转移（<0.001）、肌层浸润（<0.001）和术后辅助治疗（=0.01）与3年RFS显著相关。多因素分析确定年龄≥60岁（=0.03）、肌层浸润（=0.01）和FIGO分期（=0.046）为3年OS的独立危险因素。分子分类对于准确预测NEEC的预后至关重要，能够在临床实践中实现更具针对性的治疗方法。此外，患者年龄可能对NEEC的分类和进展有显著影响。
