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2022-RA-1364-ESGO Implementation of molecular classification in endometrial cancer and its impact on indication of adjuvant therapy
  1. Laura Cárdenas Puiggrós1,
  2. Pedro Alberto Corzo Orantos1,
  3. Isabel Núñez Márquez1,
  4. Anna Taltavull Pons1,
  5. Anna Taltavull Pons2,
  6. Cristina Meléndez Muñoz3,
  7. Anna Carbó Bagué,
  8. Hugo Javier Rosales González4,
  9. Eduard Sala Hernández1 and
  10. Elena Álvarez Castaño1
  1. 1Gynaecological Oncology Unit, Dr. Josep Trueta University Hospital, Girona, Spain
  2. 2Pathology Department, Dr. Josep Trueta University Hospital, Girona, Spain
  3. 3Medical Oncology, Catalan Institute of Oncology, Girona, Spain
  4. 4Radiation Oncology, Catalan Institute of Oncology, Girona, Spain

Abstract

Introduction/Background Adjuvant treatment in endometrial carcinoma was based on classical risk stratification which included clinicopathological data. Molecular classification has been recently incorporated into risk stratification by ESGO guidelines. The aim of this study is to describe the distribution of molecular groups in our population and to evaluate its impact on indication of adjuvant treatment.

Methodology Retrospective cohort study including all newly endometrial cancer cases diagnosed between January 2021 and April 2022 with available molecular data. Immunochemistry for TP53 and MMR proteins and Sanger sequencing for POLE mutations were done on diagnostic biopsy tissue. Risk stratification and indication of adjuvant therapy followed new histomolecular groups.

Results 66 cases were included. Table 1 shows clinicopathological data.

Abstract 2022-RA-1364-ESGO Table 1

Clinicopathological data

Molecular classification yielded 6 (9.1%) POLEmut, 17 (25.8%) MMR-D, 29 (43.9%) NSMP and 14 (21.2%) p53abn. Between POLEmut, 3 (50%) were low-grade endometrioid, while the rest were high-grade. 2 (14.3%) of p53abn were low-grade endometrioid, 2 (14.3%) high-grade endometrioid and 10 (71.4%) non-endometrioid hystotype. Regarding MMR-D cases, loss of MLH1 and PMS2 expression was observed in 11/17 (64.7%), of those MLH1 promotor hypermethylation was identified in 7/11 (63.1%). Rest of cases were referred to germline testing, although no germline mutations have been identified yet.

According to final prognostic group, 25/66 (37.9%) were low risk, 9/66 (13.6%) intermediate risk, 7/66 (10.6%) high-intermediate risk, 17/66 (25.8%) high risk. Between low-risk patients, 3 would have classified as high risk if molecular classification had not been taken account, and 2 between high-risk would have classified as low-risk. Consequently, 7.6% of cases were reclassified and adjuvant therapy adjusted.

Conclusion Implementation of molecular classification is feasible in routine clinical practice. POLEmut and p53abn are identified not only in high-grade cases but also in low-grade. Molecular classification leads to a change in adjuvant therapy in a non-negligible proportion of cases.

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