Assessing the New 2020 ESGO/ESTRO/ESP Endometrial Cancer Risk Molecular Categorization System for Predicting Survival and Recurrence

• Published in: Cancers Vol. 16; no. 5; p. 965
• Main Authors: Ouh, Yung-Taek, Oh, Yoonji, Joo, Jinwon, Woo, Joo Hyun, Han, Hye Jin, Cho, Hyun Woong, Lee, Jae Kwan, Chun, Yikyeong, Lim, Myoung-Nam, Hong, Jin Hwa
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 27.02.2024; MDPI
• Subjects: Adjuvant therapy; Cancer; Cancer patients; Cancer therapies; Cervical cancer; Classification; Development and progression; Endometrial cancer; Endometrium; Immunohistochemistry; Lymphatic system; Medical prognosis; Mismatch repair; Mortality; Oncology; Oncology, Experimental; Patient outcomes; Patients; Prognosis; Radiation therapy; Radiotherapy; Reclassification; Risk assessment; Risk factors; Risk groups; South Korea; Survival; Tumor proteins; Uterine cancer; South Korea; United States > US; endometrial cancer; mismatch repair; polymerase epsilon; molecular classification; p53
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers16050965

This study aimed to evaluate the efficacy of the 2020 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) guidelines for endometrial cancer (EC). Additionally, a novel risk category incorporating clinicopathological and molecular factors was introduced. The predictive value of this new category for recurrence and survival in Korean patients with EC was assessed, and comparisons were made with the 2013 and 2016 European Society of Medical Oncology (ESMO) risk classifications. Patients with EC were categorized into the POLE-mutated (POLEmut), mismatch repair-deficient (MMRd), p53-aberrant (P53abn), and nonspecific molecular profile (NSMP) subtypes. Recurrence, survival, and adjuvant therapy were assessed according to each classification. Notably, patients with the POLEmut subtype showed no relapse, while patients with the P53abn subtype exhibited higher recurrence (31.8%) and mortality rates (31.8%). Regarding adjuvant therapy, 33.3% of low-risk patients were overtreated according to the 2020 ESGO/ESTRO/ESP guidelines. Overall and progression-free survival differed significantly across molecular classifications, with the POLEmut subtype showing the best and the P53abn subtype showing the worst outcomes. The 2020 ESGO molecular classification system demonstrated practical utility and significantly influenced survival outcomes. Immunohistochemistry for TP53 and MMR, along with POLE sequencing, facilitated substantial patient reclassification, underscoring the clinical relevance of molecular risk categories in EC management.