Endometrial Cancer Characteristics and Risk of Recurrence

Abstract

Objectives To describe clinicopathologic characteristics and survival outcomes of endometrial adenocarcinomas stratified by mismatch repair (MMR) status. Methods Single-institution, retrospective study of all women with endometrioid adenocarcinomas treated from January 2012 through December 2017. Patients were categorized into one of three groups based on MMR testing: intact MMR expression (MMR+), probable MMR mutation (MMR–), or MLH1 hypermethylation (hMLH1+). Demographics, pathologic characteristics, recurrence rates, and survival differences were analyzed. Results In total, 316 women were included in the analysis: 235 (74.4%) patients in the MMR+ group, 10 (3.1%) in the MMR– group, and 71 (22.5%) in the hMLH1+ group. Patients with hMLH1+ were significantly older, exhibited higher-grade histology and presence of lymphovascular space invasion, and were more likely to have received adjuvant treatment. The early stage hMLH1+ patients were more likely to recur (15.3% hMLH1+ vs 2.3% MMR+ vs 12.5% MMR–, P < .001). Hypermethylation remained a significant predictor of recurrence in multivariable analysis (odds ratio, 5.09; 95% confidence interval [CI], 1.54-16.86; P = .008). Recurrence-free survival was significantly reduced in early stage hMLH1+ (hazard ratio, 7.40; 95% CI, 2.80-21.62; P < .001). Conclusions Women with hMLH1+ endometrial cancer have worse prognostic features and recur more frequently, even in patients traditionally considered low risk for recurrence.

Metabolic risk score as a predictor in a nomogram for assessing myometrial invasion for endometrial cancer

“…Although the results of the present study indicated that MRS has a significant association with MI, stratified analysis showed that more clear effects were found in certain patients, such as older patients (≥60 years), patients with a higher BMI (≥24 kg/m 2 ), patients in postmenopausal status, and those without DM or HP. It has been reported that MetSs have a significant influence in specific groups, such as in patients with postoperative complications, or in those with early-stage or low-grade tumors, which is consistent with what was observed in the present study (20)(21)(22). Since a good proportion of young patients with EC would like to preserve fertility and, to the best of our knowledge, there have been no such models or studies related to this, we may explore this in the future.…”

Research Progress of DNA Methylation in Endometrial Cancer

“…Furthermore, Bischoff et al, showed that hMLH1 promoter methylation was detected in 24 out of 64 (37.5%) primary EC and in 1 out of 18 (5.6%) metastatic tissues [ 98 ], confirming the opinion that hMLH1 promoter hypermethylation occurs in early endometrial carcinoma. Borden et al, recently reported that hMLH1 hypermethylation in EC had a strong association with higher recurrence rates and worse prognosis; hMLH1 promoter hypermethylation in individuals was more likely to recur, even in patients accompanied by low-grade, early-stage cancer [ 99 ]. In addition, Seeber et al, discovered 26% hMLH1 promoter methylation in EEC, and hMLH1 methylation was strongly associated with shorter disease-free survival and overall survival in EEC [ 20 ].…”