Endometrial cancer: molecular classification has prognostic value

  • León-Castillo A & al.
  • J Clin Oncol
  • 4 Aug 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Molecular classification has strong prognostic value in patients with high-risk endometrial carcinoma.
  • Patients with the p53abn subtype had the worst survival in this trial but experienced a significant survival benefit with adjuvant chemoradiotherapy vs radiotherapy alone.

Why this matters

  • Molecular profiling can help in treatment decision-making.

Study design

  • Molecular analysis was performed on tissue from 423 patients with high-risk endometrial cancer enrolled in the PORTEC-3 trial.
  • Funding: Dutch Cancer Society.

Key results

  • Molecular analysis was successful in 97% of patients.
  • 4 molecular cancer subtypes were identified:
    • p53abn (22.7%).
    • POLEmut (12.4%).
    • MMRd (33.4%).
    • NSMP (31.5%).
  • Respective 5-year recurrence-free survival (RFS) and OS in patients with molecular subtype:
    • p53abn: 48.0% and 54.0%.
    • POLEmut: both 98.0%.
    • MMRd: 71.7% and 81.3%.
    • NSMP: 74.4% and 88.5%.
  • Compared with the MMRd subtype, RFS (HR, 2.517; P<.001 and os were significantly worse with the p53abn subtypes p=".001).</li">
  • No significant difference in clinical outcome among histologies in patients with the p53abn subtype.
  • Patients with a p53abn molecular subtype experienced significant improvement with adjuvant chemoradiotherapy vs radiotherapy alone:
    • RFS: HR, 0.52 (P=.021).
    • OS: HR, 0.55 (P=.049).
  • Patients with the POLEmut subtype had similar RFS and OS with adjuvant chemoradiotherapy vs radiotherapy (both P=.637).

Limitations

  • Limited power for analysis by molecular subgroup.