A Modern Approach to Endometrial Carcinoma: Will Molecular Classification Improve Precision Medicine in the Future?

Abstract

Endometrial cancer has been histologically classified as either an estrogen-dependent cancer with a favorable outcome or an estrogen-independent cancer with a worse prognosis. These parameters, along with the clinical attributions, have been the basis for risk stratification. Recent molecular and histopathological findings have suggested a more complex approach to risk stratification. Findings from the Cancer Genome Atlas Research Network established four distinctive genomic groups: ultramutated, hypermutated, copy-number low and copy-number high prognostic subtypes. Subsequently, more molecular and histopathologic classifiers were evaluated for their prognostic and predictive value. The impact of molecular classification is evident and will be recognized by the upcoming WHO classification. Further research is needed to give rise to a new era of molecular-based endometrial carcinoma patient care.

Managing Difficulties of Microsatellite Instability Testing in Endometrial Cancer-Limitations and Advantages of Four Different PCR-Based Approaches

“…Thus, identification of reliable testing strategies is crucial for the best patient treatment options. Currently, IHC is widely recommended as a robust initial testing tool for the detection of dMMR in EC [ 30 ]. However, IHC still has its limitation due to inconclusive staining results in some of the samples.…”

Endometrial Cancer Molecular Characterization: The Key to Identifying High-Risk Patients and Defining Guidelines for Clinical Decision-Making?

“…Some retrospective studies revealed a potential impact of the molecular-based classification of EC on EC patients in the clinics. ESGO and ESTRO have recommended a new molecular-based clinicopathological risk stratification system for adjuvant treatment [81], where POLE-mt was assigned to the low-risk and MSI, CNH, and CNL were assigned to the intermediate-to high-risk group. In the high-risk group, chemoradiation and EBRT were recommended.…”

A radiogenomics application for prognostic profiling of endometrial cancer

“…Endometrial cancer (EC) is the most prevalent cancer of the female reproductive tract in countries ranked within the highest tier of the human developmental index, with obesity being a strong predisposing factor 1 , 2 . While most EC patients have a favorable prognosis, identification of high-risk EC disease is essential to determine optimal surgical treatment and potential adjuvant therapies 3 , 4 . Preoperative risk stratification is based on endocervical curettage (biopsy) or endometrial pipelle sample often combined with preoperative imaging, such as pelvic magnetic resonance imaging (MRI) for local staging 3 , 5 , 6 .…”