Introduction The landscape of endometrial cancer (EC) classification is undergoing a dramatic transformation as the disease moves towards molecularly driven categorization. Four molecular subtypes have been shown to portend different prognostic outcomes: POLE-hypermutated, p53 mutation, mismatch repair deficient (MMRd), and no specific molecular profile (NSMP). The recently released 2023 FIGO guidelines take into consideration histologic grade/subtype, lymphovascular invasion, and molecular categorization into staging.
Methods A retrospective review was conducted of EC patients treated between January 2018 and April 2023 at a comprehensive cancer center. Demographic information was collected, and patients were restaged according to the new guidelines. Molecular data was collected. Kaplan-Meyer progression free survival (PFS) 3-year estimates were conducted for subgroups.
Results 441 patients were included in analysis. 121 (27.4%) patients’ stages changed with the new guidelines; 118 patients were upstaged and 3 were downstaged. Upstaged patients originally stage IA had a significantly lower PFS compared to patients with no stage change (74.4% v 93.4%). A trend towards increased PFS was noted in early-stage patients when 2018 staging was compared to 2023 staging (stage I: 83.9% v 88.5%, p=0.2); stage II: 76.5% v 77.1%, p=0.6). Of the molecular data available, MMRd was the most common subtype (58/441, 13.2%) followed by p53 (57/441, 12.9%) and NSMP (51/441, 11.6%). p53 mutation negatively impacted PFS regardless of stage (stage I 28.9%, II 19.0%, III 39.4%, IV 11.7%).
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