Pre-treatment risk assessment of women with endometrial cancer: differences in outcomes of molecular and clinical classifications in the Slovenian patient cohort

Jure Knez; Monika Sobocan; Urska Belak; Rajko Kavalar; Mateja Zupin; Tomaz Büdefeld; Uros Potocnik; Iztok Takac

doi:10.2478/raon-2021-0036

Pre-treatment risk assessment of women with endometrial cancer: differences in outcomes of molecular and clinical classifications in the Slovenian patient cohort

Radiol Oncol. 2021 Sep 17;56(1):76-82. doi: 10.2478/raon-2021-0036.

Authors

Jure Knez^{1

2}, Monika Sobocan^{1

2}, Urska Belak¹, Rajko Kavalar³, Mateja Zupin⁴, Tomaz Büdefeld⁴, Uros Potocnik^{4

5}, Iztok Takac^{1

2}

Affiliations

¹ Divison of Gynecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.
² Department of Obstetrics and Gynecology, Faculty of Medicine, University of Maribor, Maribor, Slovenia.
³ Department of Pathology, University Medical Centre Maribor, Maribor, Slovenia.
⁴ Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Maribor, Slovenia.
⁵ Faculty of Chemistry and Chemical Engineering, University of Maribor, Maribor, Slovenia.

Abstract

Background: The aim of this study was to evaluate changes in prognostic risk profiles of women with endometrial cancer by comparing the clinical risk assessment with the integrated molecular risk assessment profiling.

Patients and methods: This prospective study recruited patients with biopsy proven endometrial cancer treated at the University Medical Centre Maribor between January 2020 to February 2021. Patient clinical data was assessed and categorized according to the currently valid European Society of Gynaecological Oncology, European SocieTy for Radiotherapy and Oncology, and European Society of Pathology (ESGO/ESTRO/ESP) guidelines on endometrial cancer. Molecular tumour characterization included determination of exonuclease domain of DNA polymerase-epsilon (POLE) mutational status by Sanger sequencing and imunohistochemical specimen evaluation on the presence of mismatch repair deficiencies (MMRd) and p53 abnormalities (p53abn).

Results: Fourty-five women were included in the study. Twenty-two tumours were of non-specific mutational profile (NSMP) (56.4%), 13 were classified as MMRd (33.3%), 3 were classified as p53abn (7.7%) and 1 was classified as POLE mutated (2.6%). Six tumours (15.4%) had multiple molecular classifiers, these were studied separately and were not included in the risk assessment. The clinical risk-assessment classified 21 women (53.8%) as low-risk, 5 women (12.8%) as intermediate risk, 2 women as high-intermediate risk (5.1%), 10 women (25.6%) as high risk and 1 patient as advanced metastatic (2.6%). The integrated molecular classification changed risk for 4 women (10.3%).

Conclusions: Integrated molecular risk improves personalized risk assessment in endometrial cancer and could potentially improve therapeutic precision. Further molecular stratification with biomarkers is especially needed in the NSMP group to improve personalized risk-assessment.

Keywords: endometrial cancer; molecular classification; risk assessment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

DNA Polymerase II / genetics
Endometrial Neoplasms* / pathology
Female
Humans
Prognosis
Prospective Studies
Risk Assessment

Substances

DNA Polymerase II