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p53abn Endometrial Cancer: understanding the most aggressive endometrial cancers in the era of molecular classification
  1. Amy Jamieson1,
  2. Emily F Thompson2,
  3. Jutta Huvila3,
  4. C Blake Gilks2 and
  5. Jessica N McAlpine1
  1. 1 Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 Department of Pathology, University of Turku, Turku, Finland
  1. Correspondence to Dr Jessica N McAlpine, Department of Gynecology and Obstetrics, Division Gynecologic Oncology, University of British Columbia, Vancouver, BC V5Z1M7, Canada; jessica.mcalpine{at}vch.ca

Abstract

Over the past decade, our understanding of endometrial cancer has changed dramatically from the two-tiered clinicopathologic classification system of type I and type II endometrial cancer through to the four distinct molecular subtypes identified by The Cancer Genome Atlas (TCGA) in 2013. In both systems there is a small subset of endometrial cancers (serous histotype/high numbers of somatic copy number abnormalities) that account for a disproportionately high percentage of endometrial cancer related deaths. This subset can be identified in routine clinical practice by first identifying the approximately one-third of endometrial cancers that are either ultramutated/POLEmut tumors, with pathogenic mutations in the exonuclease domain of POLE, or hypermutated/MMRd tumors, with loss of DNA mismatch repair. Immunostaining for p53 stratifies the remaining endometrial cancers into those with wild-type staining pattern and those with mutant pattern staining (p53abn endometrial cancer). This latter group of p53abn endometrial cancer is the subject of this review. Most p53abn endometrial cancers are serous type and high grade, but it also includes other histotypes and lower grade tumors, and has consistently been associated with the poorest clinical outcomes. Although it only accounts for 15% of all endometrial cancer cases, it is responsible for 50–70% of endometrial cancer mortality. A better understanding of the molecular alterations in the p53abn subgroup, beyond the ubiquitous and definitional TP53 mutations, is required so we can identify better treatments for these most aggressive endometrial cancers. Recent evidence has shown improved survival outcomes with the addition of chemotherapy compared with radiation alone in p53abn endometrial cancers. Opportunities for targeted therapy for p53abn endometrial cancers also exist with a proportion of p53abn endometrial cancers known to have homologous recombination deficiency (HRD) or human epidermal growth factor 2 (HER2) overexpression/amplification. This review will provide an overview of our current understanding of p53abn endometrial cancer.

  • endometrium
  • uterine cancer

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Footnotes

  • Contributors AJ drafted the original manuscript. All authors contributed to reviewing, editing, and approving the final manuscript. ET generated figures 1 and 4. JH generated table 1 and figure 2.

  • Funding AJ is funded by the Miller-Mindell Vancouver General Hospital Foundation Fellowship. JM has recieved funding from Canadian Institutes of Health Research, Canadian Cancer Society, Michael Smith Foundation for Health Research, Vancouver General Hospital Foundation, and BC Cancer Foundation which all supported the generation of data shared in this manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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