Fertility-sparing approach in endometrioid grade II endometrial cancer: the role of molecular classification.

IF 4.7 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Giorgio Bogani, Luigi De Vitis, Andrea Mariani, Francesco Multinu, Giuseppe Vizzielli, Fabio Ghezzi, Caterina Borso, Lilliana Galli, Carlotta Caia, Filippo Ferrari, Andrea Giannini, Enrico Vizza, Giuseppe Cucinella, Vito Chiantera, Violante Di Donato, Francesca Falcone, Mario Malzoni, Salvatore Lopez, Gennaro Cormio, Francesco Raspagliesi, Jvan Casarin
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引用次数: 0

Abstract

Objective: To investigate whether molecular classification could support individualized selection of patients with grade II endometrioid endometrial cancer for fertility-sparing approaches.

Methods: This is a retrospective multi-institutional study. Data of patients undergoing fertility-sparing treatment with a levonorgestrel intrauterine device (with or without oral hormonal therapy) were retrieved. Surrogate molecular classification was used to categorize patients into 4 classes: (1) POLE-mutated, (2) mismatch repair deficient/microsatellite instability high, (3) p53 abnormal, and (4) no specific molecular profile.

Results: Overall, data from 23 patients with grade II endometrioid endometrial cancer starting a fertility-sparing attempt were retrieved. The median patient age was 36 (range; 30-41) years. All patients underwent hysteroscopic-guided endometrial biopsies. Hysteroscopic resection of the tumor was performed in 9 (39.1%) patients. According to surrogate molecular classification, 1 (4.3%), 2 (8.7%), 3 (13.1%), and 17 (73.9%) patients were classified as POLE-mutated, p53 abnormal, mismatch repair deficient/microsatellite instability high, and no specific molecular profile, respectively. Molecular classification was not associated with 6-month response rates (p = .080) nor with best response rates (p = .366). Overall, 7 women attempted to achieve a pregnancy; 3 underwent in vitro fertilization. Three patients achieved a pregnancy (1 first-trimester miscarriage and 2 term live births). A total of 10 (43.4%) patients were diagnosed with progressive disease during hysteroscopic surveillance. Overall, 19 (82.6%) patients required hysterectomy. Three (13%) patients required adjuvant therapy for the presence of locally advanced disease (1 stage II, and 2 stage III). Over a median (range) follow-up of 28.7(8.2-91.1) months, no recurrence or disease-related death occurred.

Conclusions: Less than 10% of women with grade II endometrioid endometrial cancer starting a fertility-sparing attempt achieve a term pregnancy. In our series, molecular classification did not influence response rate. Further collaborative registers are needed.

保留生育能力的方法在子宫内膜样II级子宫内膜癌中的作用:分子分类。
目的:探讨分子分类是否能支持II级子宫内膜样子宫内膜癌患者选择保留生育能力的入路。方法:这是一项多机构回顾性研究。采用左炔诺孕酮宫内节育器(含或不含口服激素治疗)进行生育保留治疗的患者资料被检索。采用替代分子分类将患者分为4类:(1)pole突变,(2)错配修复缺陷/微卫星不稳定性高,(3)p53异常,(4)无特异性分子谱。结果:总体而言,我们检索了23例II级子宫内膜样癌患者的数据,这些患者开始尝试保留生育能力。患者年龄中位数为36岁(范围30-41岁)。所有患者均行宫腔镜引导下的子宫内膜活检。9例(39.1%)患者行宫腔镜下肿瘤切除术。根据替代分子分类,1例(4.3%),2例(8.7%),3例(13.1%),17例(73.9%)患者分别被分类为pole突变,p53异常,错配修复缺陷/微卫星不稳定性高,无特异性分子谱。分子分类与6个月缓解率(p = 0.080)和最佳缓解率(p = 0.366)无关。总共有7名妇女试图怀孕;3例接受体外受精。3例患者成功妊娠(1例妊娠早期流产,2例足月活产)。共有10例(43.4%)患者在宫腔镜监测中被诊断为进展性疾病。总体而言,19例(82.6%)患者需要子宫切除术。3例(13%)患者因出现局部晚期疾病(1例II期,2例III期)而需要辅助治疗。中位(范围)随访28.7(8.2-91.1)个月,未发生复发或疾病相关死亡。结论:只有不到10%的II级子宫内膜样子宫内膜癌患者开始保留生育能力的尝试,最终实现足月妊娠。在我们的研究中,分子分类并不影响应答率。需要进一步的协作寄存器。
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来源期刊
CiteScore
6.60
自引率
10.40%
发文量
280
审稿时长
3-6 weeks
期刊介绍: The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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