ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma

Abstract

Initiated through ESGO the decision to develop multidisciplinary guidelines has been made jointly by the ESGO, ESTRO, and ESP. The ESGO has provided administrative support. The ESGO, ESTRO and ESP are nonprofit knowledgeable societies.The development group (including all authors) is collectively responsible for the decision to submit for publication. Nicole Concin (chair), Carien L. Creutzberg (cochair), Xavier Matias-Guiu (co-chair) and François Planchamp (methodologist) have written the first draft of the manuscript. All other contributors have actively given personal input, reviewed the manuscript, and have given final approval before submission.

New Pathological and Clinical Insights in Endometrial Cancer in View of the Updated ESGO/ESTRO/ESP Guidelines

“…Instead, high-grade EECs show a significantly higher proportion in the MMRd group (which is the most represented), p53mut group, and POLEmut group [ 21 ]. The ESGO/ESTRO/ESP guidelines consider all POLEmut EEC up to stage II at low risk regardless of other pathological factors [ 18 ], indicating that these cases do not need adjuvant treatment. Indeed, a recent meta-analysis showed a 0% risk of nodal metastases in POLEmut carcinomas [ 22 ].…”

“…Indeed, a recent meta-analysis showed a 0% risk of nodal metastases in POLEmut carcinomas [ 22 ]. The biological behavior of POLEmut EEC at FIGO stage >II is still unclear, given the rarity of these cases [ 18 ]. All p53abn EECs lumped together with non-endometrioid carcinomas; hence, they are considered at intermediate risk in the absence of myometrial invasion and at high-risk in the case of myoinvasive disease.…”

“…Consistently, SECs almost invariably fall into the p53abn TCGA group, which has indeed been termed the “serous-like” group [ 12 , 33 ]. Similarly to the other non-endometrioid histotypes, SEC is placed in the high-risk category in the case of myoinvasive disease and in the intermediate-risk category when there is an absence of myometrial invasion [ 18 ]. Although SEC appears as the most prognostically and molecularly homogeneous histotype of endometrial carcinoma, there are some exceptions that should be remarked.…”

“…However, while the prognosis of p53abn CCEC is considered poor, the prognosis of MMRd and NSMP CCEC is less defined. Such a knowledge gap is clearly highlighted in the ESGO/ESTRO/ESP guidelines [ 18 ]. Interestingly, the few studied focused on CCEC and mixed EEC/CCEC showed excellent prognosis for MMRd CCEC [ 42 , 43 , 44 ].…”

“…The most evident novelties are that all POLEmut carcinomas up to FIGO stage II, regardless of FIGO grade, histotype, or LVSI, are included in the low-risk group; this implies that these cases would be managed by observation alone, with no need for adjuvant treatment. On the other hand, p53mut EECs are lumped together with non-endometrioid carcinomas in the high-risk group; in the absence of myometrial invasion, these tumors are considered at intermediate risk [ 18 ]. However, there are still several points that should be clarified, since prognostic value of the TCGA molecular groups might vary across the different histotypes of endometrial carcinoma [ 19 ].…”