Significance of molecular classification in fertility-sparing treatment of endometrial carcinoma and atypical endometrial hyperplasia
10.3760/cma.j.cn112141-20220628-00419
- VernacularTitle:分子分型在早期子宫内膜癌及子宫内膜非典型增生患者保留生育功能治疗中的意义
- Author:
Yiqin WANG
1
;
Nan KANG
;
Liwei LI
;
Zhiqi WANG
;
Rong ZHOU
;
Danhua SHEN
;
Jianliu WANG
Author Information
1. 北京大学人民医院妇产科，北京 100044
- Keywords:
Endometrial neoplasms;
Endometrial hyperplasia;
Fertility preservation;
Genomics;
Treatment outcome
- From:
Chinese Journal of Obstetrics and Gynecology
2022;57(9):692-700
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the molecular classification of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) treated with fertility-sparing therapy, and to analyze its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 46 EC and AEH patients who received fertility-sparing therapy and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2021, were retrospectively collected. The relationships between molecular classification and clinicopathological factors and treatment outcomes were analyzed.Results:(1) Of the 46 patients, including 40 EC and 6 AEH patients, 32 cases (71%, 32/45) had complete response (CR) after treatment, with median CR time of 8 months, 6 cases (13%, 6/45) had partial response, and 8 cases (25%, 8/32) had recurrence. (2) The cases were distributed as no specific molecular profile (NSMP) 34 cases (74%, 34/46) subtype mainly, high microsatellite instability (MSI-H) 7 cases (15%, 7/46), POLE ultra-mutated 3 cases (7%, 3/46), and copy number high (CNH) 2 cases (4%, 2/46). Patients with CNH had the hightest serum cancer antigen 125 (CA 125) level [(34.3±35.2) kU/L]. MSI-H subtype had more family history of tumors (6/7), more with loss of mismatch repair (MMR) protein expression by immunohistochemical (7/7), and higher nuclear antigen associated with cell proliferation (Ki-67) expression level (3/3). (3) Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6; P=0.019), and survival analysis showed that they were less likely to achieve CR than those with NSMP subtype ( P=0.022). Subgroup analysis of patients with NSMP showed that age ≥30 years related with longer treatment time to CR ( P=0.010). In addition, CR was obtained after treatment in 2/3 POLE ultra-mutated cases and 2/2 CNH, respectively. Conclusions:Molecular classification relates with the treatment response in patients with EC and AEH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy, and patients with NSMP need to be further studied and predict treatment benefit. However, there are few cases in POLE ultra-mutated and CNH subtypes, which need further clinical research.
