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Application of precision medicine: can molecular risk stratification provide new management options for low stage endometrioid ovarian carcinoma?
  1. P Krämer1,
  2. A Talhouk2,
  3. T Bosse3,
  4. F Heitz4,5,
  5. S Prader4,
  6. N Singh6,
  7. F Kommoss7,
  8. B Krämer1,
  9. A Hartkopf1,
  10. S Brucker1,
  11. J McAlpine2,8,
  12. M Koebel9,
  13. M Anglesio2,10 and
  14. S Kommoss1
  1. 1Department of Women’s Health, Tuebingen University Hospital, Tuebingen, Germany
  2. 2Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
  3. 3Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4Department of Gynecology and Gynecologic Oncology, Kliniken Essen Mitte, Essen
  5. 5Department of Gynecology and Gynecologic Oncology, Charité Campus Virchow-Klinikum, Berlin, Germany
  6. 6Department of Pathology, Barts Health NHS Trust, London, UK
  7. 7Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
  8. 8Department of Molecular Oncology, BC Cancer Research Centre, Vancouver, BC
  9. 9Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, AB
  10. 10Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada


Introduction/Background Endometrioid ovarian carcinoma (ENOC) is generally associated with a more favorable prognosis compared to other ovarian carcinoma histotypes. Nonetheless, patients are still treated according to a ‘one size fits all’ approach. While tumor staging offers some stratification, the development of personalized treatment concepts remain elusive. Our group has recently shown that the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE), also provides additional prognostic information in it’s ovarian endometrioid counterpart. The aim of this study was to investigate ProMisE in a large cohort of low stage (FIGO I-II) ovarian endometrioid carcinoma.

Methodology After establishment of prognostic groups in >500 ENOC we examined a subset of n=379 FIGO stage I-II cases. Cases were aligned into low risk POLE mutant (POLE); moderate risk mismatch repair deficient (MMRd); high-risk p53 abnormal (p53abn); and a final moderate risk category lacking these biomarkers (p53wt). Kaplan-Meier survival analysis was performed.

Results 4% of cases were POLE, 15% MMRd, 73% p53wt and 8% p53abn. Groups showed distinct progression-free and overall survival (p<0.01). 5-year PFS and OS was 74% in p53abn, 89% in MMRd, 93% in p53wt, and 100% in POLE cases.

Conclusion ProMisE risk classification provides additional prognostic information in a large cohort of low stage ENOC. In the context of low-stage ENOC, and especially younger women wishing to preserve fertility, the introduction of ProMisE-stratified treatment algorithms may serve not only to improve patient care overall but to reduce chemotherapy burden and highlight cases where fertility-sparing surgeries pose little or no risk.

Disclosure Nothing to disclose.

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