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632 Patterns of recurrence and prognostic factors in endometrial cancer molecular subtypes
  1. Clarissa Lam1,
  2. Christian Dagher1,
  3. Lora H Ellenson2,
  4. Jennifer J Mueller1,
  5. Britta Weigelt3,
  6. Nadeem Abu-Rustum1 and
  7. Amir Momeni-Boroujeni2
  1. 1Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, USA
  2. 2Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
  3. 3Memorial Sloan Kettering Cancer Center, New York, USA


Introduction/Background To identify the anatomic distribution of endometrial cancer recurrences among the different molecular subtypes and evaluate the prognostic significance of molecular subtypes in the recurrent setting.

Methodology All patients with endometrial cancer who had their initial staging surgery performed at our institution between 2014 and 2023 and had a biopsy-proven recurrence and molecular subtyping of their primary tumor were included in the study. Sites of recurrence were determined by clinical and imaging review.

Results A total of 186 patients met the inclusion criteria and were included in the study. Tumor molecular subtypes were as follows: copy number-high (CN-H)/TP53 abnormal, 121 (65%); microsatellite instability-high (MSI-H), 34 (18%); copy number-low (CN-L)/no specific molecular subtype (NSMP), 29 (16%); and POLE ultramutated, 2 (1%). CN-H tumors were most likely to present with extrapelvic recurrence, even after stratification by stage I disease at initial diagnosis (19/27, 70%). Of the 15 patients who presented with isolated vaginal cuff recurrence, the most likely histology was endometrioid. The absence of a TP53 mutation and the presence of either CTNNB1, PTEN, or RB1 mutation were more likely to be associated with isolated vaginal cuff recurrence (p<0.01). At the time of recurrence, overall survival was shortest in CN-H endometrial cancers (median: 31 months) and longest in POLE-ultramutated cancers (no mortality observed), with intermediate survival noted in the CN-L and MSI-H subtypes (p<0.001).

Conclusion In patients with recurrent endometrial cancer, TCGA molecular subtyping remains informative for oncologic outcomes and patterns of recurrence.

Disclosures None.

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