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Relevance of Molecular Profiling in Patients With Low-Grade Endometrial Cancer
SW. Vrede, J. Kasius, J. Bulten, S. Teerenstra, J. Huvila, E. Colas, A. Gil-Moreno, D. Boll, MC. Vos, AM. van Altena, J. Asberger, S. Sweegers, WJ. van Weelden, LJM. van der Putten, F. Amant, NCM. Visser, MPLM. Snijders, HVN. Küsters-Vandevelde,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu multicentrická studie, časopisecké články
NLK
Directory of Open Access Journals
od 2018
ProQuest Central
od 2018-01-01
Health & Medicine (ProQuest)
od 2018-01-01
- MeSH
- endometroidní karcinom * patologie MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory endometria * MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
IMPORTANCE: Patients with low-grade (ie, grade 1-2) endometrial cancer (EC) are characterized by their favorable prognosis compared with patients with high-grade (ie, grade 3) EC. With the implementation of molecular profiling, the prognostic relevance of tumor grading might lose attention. As most patients present with low-grade EC and have an excellent outcome, the value of molecular profiling for these patients is unclear. OBJECTIVE: To determine the association of molecular profiling with outcomes among patients with low-grade EC. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included a multicenter international European cohort of patients diagnosed with EC between 1994 and 2018, with a median follow-up of 5.9 years. Molecular subgroups were determined by next-generation sequencing using single-molecule molecular inversion probes and by immunohistochemistry. Subsequently, tumors were classified as polymerase epsilon (POLE)-altered, microsatellite instable (MSI), tumor protein p53 (TP53)-altered, or no specific molecular profile (NSMP). Patients diagnosed with any histological subtypes and FIGO (International Federation of Gynecology and Obstetrics) stages of EC were included, but patients with early-stage EC (FIGO I-II) were only included if they had known lymph node status. Data were analyzed February 20 to June 16, 2022. EXPOSURES: Molecular testing of the 4 molecular subgroups. MAIN OUTCOMES AND MEASURES: The main outcome was disease-specific survival (DSS) within the molecular subgroups. RESULTS: A total of 393 patients with EC were included, with a median (range) age of 64.0 (31.0-86.0) years and median (range) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 29.1 (18.0-58.3). Most patients presented with early-stage (290 patients [73.8%]) and low-grade (209 patients [53.2%]) disease. Of all patients, 33 (8.4%) had POLE-altered EC, 78 (19.8%) had MSI EC, 72 (18.3%) had TP53-altered EC, and 210 (53.4%) had NSMP EC. Across all molecular subgroups, patients with low-grade EC had superior 5-year DSS compared with those with high-grade EC, varying between 90% to 100% vs 41% to 90% (P < .001). Multivariable analysis in the entire cohort including age, tumor grade, FIGO stage, lymphovascular space invasion, and the molecular subgroups as covariates found that only high-grade (hazard ratio [HR], 4.29; 95% CI, 2.15-8.53; P < .001), TP53-altered (HR, 1.76; 95% CI, 1.04-2.95; P = .03), and FIGO stage III or IV (HR, 4.26; 95% CI, 2.50-7.26; P < .001) disease were independently associated with reduced DSS. CONCLUSIONS AND RELEVANCE: This cohort study found that patients with low-grade EC had an excellent prognosis independent of molecular subgroup. These findings do not support routine molecular profiling in patients with low-grade EC, and they demonstrate the importance of primary diagnostic tumor grading and selective profiling in low-grade EC to increase cost-effectiveness.
Departement of Obstetrics and Gynecology Elisabeth Tweesteden Hospital the Netherlands
Department of Health Evidence Radboud University Medial Center Nijmegen the Netherlands
Department of Obstetrics and Gynecology Canisius Wilhelmina Hospital Nijmegen the Netherlands
Department of Obstetrics and Gynecology Catharina Hospital Eindhoven the Netherlands
Department of Obstetrics and Gynecology Medical Center University of Freiburg Freiburg Germany
Department of Obstetrics and Gynecology Radboud University Medical Center Nijmegen the Netherlands
Department of Oncology KU Leuven Leuven Belgium
Department of Pathology Canisius Wilhelmina Hospital Nijmegen the Netherlands
Department of Pathology Radboud University Medical Center Nijmegen the Netherlands
Department of Pathology University of Turku Turku Finland
Department of Radiation Oncology Radboud University Medical Center Nijmegen the Netherlands
Citace poskytuje Crossref.org
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