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Abstract
Introduction/Background Molecular profiling in endometrial cancer(EC) is a consistent information that we may obtain from the pre-operative specimen. Nevertheless, its use for making surgical decisions has been barely explored. We aimed to analyze the impact of molecular profile in EC from a surgical perspective, to identify which tumors will most benefit from an extensive surgery and in which it could be avoided safely.
Methodology A cohort of 689 patients with EC treated at Hospital Vall d’Hebron, Barcelona, from 1992–2022 were retrospectively recruited. Clinical, surgical and pathological data were reviewed, and molecular profiling was performed in surgical specimen or preoperative biopsy. Tumors were classified according recommendations for molecular classification reported in ESGO-ESTRO-ESP 2020 Guidelines on EC.
Results The distribution of the cohort was as follows: 47 patients were POLEmut EC(6.8%), 104 patients p53abn EC(15.1%), 242 patients MSI EC(35.1%) and 296 patients NSMP(43%). Patients with POLEmut EC were significantly younger (57 y) and p53abn EC were elderly (67 y) than the rest of the cohorts(64 y, p=0.026). Patients with p53abn EC showed a higher proportion of non-endometrioid histologies (table 1).
Advanced FIGO stages III-IV (FIGO 2009) were diagnosed as follows: 7% of MSI cohort, 9.8% of NSMP cohort, 2% of POLEmut cohort and 39.2% of p53abn cohort. 30.1% of the patients p53abn EC had lymph-node involvement (versus 9.5% NSMP, 6.8% MSI and 0% POLEmut, p<0.001). 7.7% of patients with p53abn EC had peritoneal spread at diagnostic (versus 2.4% NSMP, 0.4% MSI and 2.1% POLEmut, p<0.001). After a median follow-up of 4.2 y(1.4–7.9 y), the p53abn cohort showed the poorest overall survival (51.6%) and disease-free survival (31%) compared to rest of the groups. (figure 2).
Conclusion p53abn EC represents a subset of patients diagnosed with high rates of lymph-node involvement and peritoneal spread, and shows the worst oncological results in terms of survival.