Molecular classification in fertility-sparing treatment of early-stage endometrial cancer: A potential tool for optimizing patient selection

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2024-10-25 DOI:10.1016/j.ygyno.2024.10.012

Shiyi Peng , Ying Zheng , Jianhong Liu , Sijing Chen , Kaixuan Yang , Wei Wang , Gang Ning , Xiao Tang , Lei Li , Zhijun Ye , Yunwei Ouyang , Zhongying Huang , Qianhong Ma , Fan Yang , Aiyun Xing , Yuedong He , Ping Wang , Xiaoyun Yang , Zhilan Peng

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引用次数: 0

Abstract

Objective

To investigate the prognostic significance of molecular classification on treatment outcomes of fertility-sparing treatment (FST) in early-stage endometrial cancer (EC), and its potential in optimizing fertility-sparing management.

Methods

Patients with early-stage EC who received FST with ProMisE classification were investigated. Oncological and reproductive outcomes were compared across four molecular subtypes. Factors influencing complete response (CR) were analyzed.

Results

Among 116 molecularly classified patients, 80 were evaluated for therapeutic effects, including 64 (80.0 %) p53wt, 7 (8.7 %) MMR-D, 5 (6.3 %) POLE EDM, and 4 (5.0 %) p53abn. Overall CR rates were comparable across four molecular subtypes, with 92.2 % of p53wt, 71.4 % of MMR-D, 100.0 % of POLE EDM, and 75.0 % of p53abn (P = 0.145). MMR-D patients needed the longest median treatment time to achieve CR (7.9 months, range 3.5–15.9), while POLE EDM required the shortest (3.0 months, range 2.8–6.4), followed by p53abn (3.5 months, range 3.0–3.7) and p53wt (3.7 months, range 2.2–22.8) (P = 0.049). Among 14 p53wt patients with superficial myometrial invasion (MI) or G2 histology, 13 (92.9 %) achieved CR, and of 8 who attempted to conceive,4 delivered. Multivariable analysis identified MMR-D, superficial MI and insulin resistance negatively predicted CR, while POLE EDM was a positive factor.

Conclusions

Molecular classification of EC may serve as a tool for predicting response to FST and assist in identifying candidates for FST. POLE EDM patients tended to obtain promising outcomes. MMR-D cases should be cautiously administrated for FST with close surveillance. Patients with p53wt demonstrated favorable outcomes, including those with superficial MI or G2 EC. Patients with endometrium-confined p53abn tumors may benefit from FST. However, given the small sample sizes of certain subtypes, further investigation is necessary to validate these findings.

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早期子宫内膜癌保胎治疗中的分子分类：优化患者选择的潜在工具

目的研究分子分级对早期子宫内膜癌（EC）保孕治疗（FST）结果的预后意义，以及其在优化保孕治疗中的潜力：方法：研究人员对接受了 ProMisE 分级 FST 的早期子宫内膜癌患者进行了调查。比较了四种分子亚型的肿瘤和生育结果。分析了影响完全应答（CR）的因素：在116例分子分类患者中，80例接受了疗效评估，包括64例（80.0%）p53wt患者、7例（8.7%）MMR-D患者、5例（6.3%）POLE EDM患者和4例（5.0%）p53abn患者。四种分子亚型的总体 CR 率相当，p53wt 为 92.2%，MMR-D 为 71.4%，POLE EDM 为 100.0%，p53abn 为 75.0%（P = 0.145）。MMR-D 患者达到 CR 所需的中位治疗时间最长（7.9 个月，范围 3.5-15.9），而 POLE EDM 所需的时间最短（3.0 个月，范围 2.8-6.4），其次是 p53abn（3.5 个月，范围 3.0-3.7）和 p53wt（3.7 个月，范围 2.2-22.8）（P = 0.049）。在 14 名有浅表子宫肌层浸润（MI）或 G2 组织学的 p53wt 患者中，13 人（92.9%）达到 CR，8 人试图怀孕，其中 4 人顺利分娩。多变量分析表明，MMR-D、浅表MI和胰岛素抵抗对CR有负面预测作用，而POLE EDM则是一个积极因素：结论：EC的分子分类可作为预测对FST反应的工具，并有助于确定FST的候选者。POLE EDM患者往往能获得良好的疗效。MMR-D病例应谨慎接受FST治疗，并进行密切监测。p53wt患者的预后良好，包括浅表MI或G2 EC患者。子宫内膜封闭的 p53abn 肿瘤患者可能会从 FST 中获益。然而，鉴于某些亚型的样本量较小，有必要进一步调查以验证这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy