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18 Multiple classifier endometrial cancer: a multicenter study
  1. Giorgio Bogani1,
  2. Ilaria Betella2,
  3. Francesco Multinu3,
  4. Flavia Sorbi4,
  5. Jvan Casarin5,
  6. Mariangela Longo6,
  7. Nicoletta Colombo7,
  8. Giovanni Scambia8,
  9. Francesco Fanfani9,
  10. Andrea Mariani10,
  11. Roberto Berretta11,
  12. Violante Di Donato9,
  13. Andrea Giannini12,
  14. Giuseppe Vizzielli13,
  15. Marco Petrillo14,
  16. Stefano Cianci15,
  17. Valentina Chiappa16 and
  18. Francesco Raspagliesi17
  1. 1IRCCS National Cancer Institute, Milano, Italy
  2. 2Department of Gynecologic Oncology, Milan, Italy
  3. 3European Institute of Oncology, Milan, Italy
  4. 4Department of Gynecologic Surgery, Firenze, Italy
  5. 5IRCCS European Institute of Oncology, Varese, Italy
  6. 6University of Firenze, Varese, Italy
  7. 7Department of Obstetrics and Gynecology, Milan, Italy
  8. 8Women’s and Children’s Del Ponte Hospital, Rome, Italy
  9. 9University of Insubria, Rome, Italy
  10. 10Department of Obstetrics and Gynecology, Rochester, USA
  11. 11Filippo Del Ponte Hospital, Parma, Italy
  12. 12Department of Gynecology, Rome, Italy
  13. 13European Institute of Oncology, Udine, Italy
  14. 14IEO, Sassari, Italy
  15. 15IRCCS, Messina, Italy
  16. 16Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
  17. 17Fondazione Policlinico Universitario Agostino Gemelli, Milan, Italy


Introduction/Background The growing adoption of molecular and genomic characterization is changing the current landscape of treatment of endometrial cancer patients. Using the surrogate molecular classification endometrial cancer patients are classified into four subgroups: POLE mutated, MMRd/MSI-H, p53 abnormal, and no specific mutational profile (NSMP). However, there are few patients (called multiple classifiers) harboring two or more mutational patterns. Since the rarity of this occurrence, evidence regarding multiple classifiers is still limited. Here, we described the characteristics and outcomes of multiple classifiers.

Methodology This is a multi-institutional retrospective study. Apparent early-stage endometrial cancer patients were evaluated via conventional pathological analysis and via immunohistochemistry and next-generation sequencing.

Results Charts of 72 multiple classifiers were reviewed. Median (range) follow-up was 9.8 (1.2, 37.5) months. Overall, 31 (43%) patients had a POLE mutation. Patients with POLE plus MMRd/MSI-H, POLE plus p53, and POLE plus MMRd/MSI-H, and p53 were 6 (8.3%), 20 (27.8%), and 5 (6.9%), respectively. Among those 31 patients, six had postoperative adjuvant therapies, and no recurrence occurred (median follow-up: 10.5 months (seven patients had at least 2-year follow-up)). Forty-one (56.9%) patients were diagnosed with tumors harboring both p53 plus MMRd/MSI-H. Adjuvant therapy was administered in 25/41 patients (60.9%). Four (9.8%) recurrences occurred after a median follow-up of 8.9 months (eleven non-recurring patients had at least a 2-year follow-up).

Conclusion Multiple-classifier endometrial cancers are characterized by a good prognosis. POLE mutation seems to confer protection in multiple classifier endometrial cancer even in the case of the presence of MMRd/MSI-H and/or p53 abnormality. Prospective studies with long-term follow-up are needed.

Disclosures None.

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