Molecular Classification Guides Fertility-Sparing Treatment for Endometrial Cancer and Atypical Hyperplasia Patients.

IF 3.4 4区 医学 Q2 ONCOLOGY
Yiqin Wang, Linlin Bo, Xiaowei Fan, Nan Kang, Xiaobo Zhang, Li Tian, Rong Zhou, Jianliu Wang
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引用次数: 0

Abstract

Objectives: The objective of this study was to investigate the significance of molecular classification in guiding treatment decisions for patients with endometrial cancer (EC) or atypical hyperplasia (AH) undergoing fertility-sparing treatment (FST), particularly for those with non-NSMP subtypes.

Methods: We conducted a retrospective cohort study involving EC/AH patients undergoing FST and molecular classification using next-generation sequencing at Peking University People's Hospital between June 2020 and September 2023.

Results: A total of 118 EC/AH patients were included, including 92 cases with NSMP, 11 with MMRd, 11 with POLEmut, and 4 with p53abn. (1) Of the 11 patients with MMRd, 6 achieved a complete response (CR) with 1 case receiving progestin, 3 cases showed insensitivity to the initial progestin before transitioning to a combined regimen of progestin and a PD-1 inhibitor, and 2 cases initially received progestin plus a PD-1 inhibitor. There were no significant differences in the cumulative CR rates between the MMRd and NSMP subgroups but a trend of a lower relapse-free-survival (RFS) rate for the MMRd subgroup (p = 0.074). (2) Of the 11 cases with POLEmut, 10 achieved CR but 4 relapsed. There was also a trend for a lower RFS rate in the POLEmut patients (p = 0.069) compared with the NSMP subgroup. (3) Three of the four patients with p53mut achieved CR after treatment with the GnRHa plus LNG-IUS regimen.

Conclusion: The selection of appropriate regimens may improve FST outcomes in EC/AH patients with molecular classification of non-NSMP subtypes. Immunotherapy is an effective fertility-preserving approach for patients with MMRd.

分子分类指导子宫内膜癌和不典型增生患者保留生育能力的治疗。
目的:本研究的目的是探讨分子分类在指导子宫内膜癌(EC)或非典型增生(AH)患者接受生育保留治疗(FST)的治疗决策中的意义,特别是对于那些非nsmp亚型的患者。方法:我们对2020年6月至2023年9月在北京大学人民医院接受FST和使用下一代测序进行分子分类的EC/AH患者进行了回顾性队列研究。结果:共纳入118例EC/AH患者,其中NSMP 92例,MMRd 11例,POLEmut 11例,p53abn 4例。(1) 11例MMRd患者中,6例获得完全缓解(CR),其中1例接受黄体酮治疗,3例在过渡到黄体酮和PD-1抑制剂联合治疗前对黄体酮不敏感,2例最初接受黄体酮加PD-1抑制剂治疗。MMRd亚组和NSMP亚组的累积CR率无显著差异,但MMRd亚组的无复发生存率(RFS)有较低的趋势(p = 0.074)。(2) 11例POLEmut患者中,10例达到CR, 4例复发。与NSMP亚组相比,POLEmut患者的RFS率也有降低的趋势(p = 0.069)。(3) 4例p53mut患者中有3例经GnRHa + LNG-IUS方案治疗后达到CR。结论:选择合适的方案可以改善分子分类为非nsmp亚型的EC/AH患者的FST结果。免疫治疗是保留MMRd患者生育能力的有效方法。
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来源期刊
Current oncology
Current oncology ONCOLOGY-
CiteScore
3.30
自引率
7.70%
发文量
664
审稿时长
1 months
期刊介绍: Current Oncology is a peer-reviewed, Canadian-based and internationally respected journal. Current Oncology represents a multidisciplinary medium encompassing health care workers in the field of cancer therapy in Canada to report upon and to review progress in the management of this disease. We encourage submissions from all fields of cancer medicine, including radiation oncology, surgical oncology, medical oncology, pediatric oncology, pathology, and cancer rehabilitation and survivorship. Articles published in the journal typically contain information that is relevant directly to clinical oncology practice, and have clear potential for application to the current or future practice of cancer medicine.
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