I期高级别子宫内膜癌分子亚群的复发模式

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Gynecologic oncology Pub Date : 2025-04-22 DOI:10.1016/j.ygyno.2025.04.576

Alicia León-Castillo , Nanda Horeweg , Elke E.M. Peters , Natalja ter Haar , Vincent T.H.B.M. Smit , Cor D. de Kroon , Marie Boennelycke , Estrid Hogdall , Claus Hogdall , Remi R.A. Nout , Carien L. Creutzberg , Tjalling Bosse , Gitte Ortoft

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Stage I high-grade NSMP and p53abn EC had high recurrence rates (5-year overall recurrence rate 29 % (95 % CI 16–48) and 35 % (95 % CI 27–45), respectively), mostly presenting with abdominal (NSMP EC <em>n</em> = 1 (3.0 %); p53abn EC <em>n</em> = 28 (22.4 %)) or distant recurrences (NSMP EC <em>n</em> = 8 (24.2 %); p53abn EC <em>n</em> = 21 (16.8 %)).</div></div><div><h3>Conclusion</h3><div>Stage I high-grade EC present more frequently with abdominal and distant recurrences rather than isolated loco-regional recurrences, independently of molecular subgroup. Stage I high-grade <em>POLE</em>mut EC and MMRd EC have a favorable prognosis with few recurrences, even with no adjuvant treatment. 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引用次数: 0

摘要

目的探讨子宫内膜癌（EC）复发模式对抢救治疗的影响及预后。我们评估了未接受辅助治疗的I期高级别疾病患者和经淋巴结切除术分期的患者EC分子亚组的复发率和分布模式。方法对来自丹麦妇科癌症数据库的412例高级别EC进行分子分析，并将其分为POLE突变型（POLEmut）、错配修复缺陷型（MMRd）、p53异常型（p53abn）和无特异性分子谱型（NSMP） EC。II-IV期（FIGO 2009）或术后残留疾病的患者被排除在外。计算粗复发率和精算复发率。结果I期高级别POLEmut和MMRd EC在未接受辅助治疗时也很少复发(5年总复发率分别为7% （95% CI 3-16）和6% （95% CI 2-22）。I期高级别NSMP和p53abn EC复发率高（5年总复发率分别为29% （95% CI 16-48）和35% (95% CI 27-45)），主要表现为腹部(NSMP EC n = 1 (3.0%)；p53abn EC n = 28(22.4%))或远处复发(NSMP EC n = 8 (24.2%)；p53abn EC n = 21(16.8%))。结论与分子亚群无关，I期高级别EC更常见的是腹部和远处复发，而不是孤立的局部区域复发。I期高级别POLEmut EC和MMRd EC预后良好，即使不进行辅助治疗，也很少复发。I期高级别NSMP和p53abn EC具有高复发率，经常伴有腹部或远处复发，强调需要研究对这些患者更有效的辅助全身治疗。

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Pattern of recurrence of the molecular subgroups in stage I high-grade endometrial cancer

Objective

Patterns of recurrence may impact the possibilities for salvage treatment and prognosis of patients with endometrial carcinoma (EC). We evaluated the recurrence rate and distribution pattern of the molecular EC subgroups in patients with stage I high-grade disease without adjuvant treatment and those staged by lymphadenectomy.

Method

412 high-grade EC from the Danish Gynecological Cancer Database were molecularly profiled and classified into POLE mutant (POLEmut), mismatch repair deficient (MMRd), p53-abnormal (p53abn) or no specific molecular profile (NSMP) EC. Patients with stage II-IV (FIGO 2009) or residual disease after surgery were excluded. Crude and actuarial recurrence rates were calculated.

Results

Stage I high-grade POLEmut and MMRd EC rarely recurred (5-year overall recurrence rate 7 % (95 % CI 3–16) and 6 % (95 % CI 2–22), respectively), also when not receiving adjuvant treatment. Stage I high-grade NSMP and p53abn EC had high recurrence rates (5-year overall recurrence rate 29 % (95 % CI 16–48) and 35 % (95 % CI 27–45), respectively), mostly presenting with abdominal (NSMP EC n = 1 (3.0 %); p53abn EC n = 28 (22.4 %)) or distant recurrences (NSMP EC n = 8 (24.2 %); p53abn EC n = 21 (16.8 %)).

Conclusion

Stage I high-grade EC present more frequently with abdominal and distant recurrences rather than isolated loco-regional recurrences, independently of molecular subgroup. Stage I high-grade POLEmut EC and MMRd EC have a favorable prognosis with few recurrences, even with no adjuvant treatment. Stage I high-grade NSMP and p53abn EC have a high recurrence rate, frequently with abdominal or distant recurrences, underscoring the need to investigate more effective adjuvant systemic treatments for these patients.

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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