Meta-analysis of the ability of mutational profiles on the cancer genome atlas to predict prognosis in endometrial carcinoma.

Abstract

Background: In 2013, The Cancer Genome Atlas Research Network suggested that endometrial carcinoma patients may be reclassified into four molecular prognostic groups.

Objective: To compare survival of endometrial carcinoma patients with different mutational profiles.

Search strategy: Studies reporting survival of endometrial carcinoma patients were identified through systematic searches of four databases.

Selection criteria: We included relevant studies based on the literature type, data integrity and the methodological quality.

Data collection and analysis: The pooled survival data were compared among patients with different mutational profiles. Heterogeneity in the pooled data was assessed using the I² statistic.

Main results: Data were meta-analyzed from nine studies involving 4755 patients, who were classified into the following mutational profiles: p53abn, 745 patients (15.6%); MMRd, 1454 patients (30.6%); POLEmut, 351 patients (7.4%); and p53wt, 2205 patients (46.4%). Compared to the p53wt group, the p53abn group showed significantly worse overall survival (OS) (HR 2.31, 95% CI: 1.67-3.19), progression-free survival (PFS) (HR 2.86, 95% CI: 1.45-5.64) and disease-specific survival (HR 2.60, 95% CI: 1.41-4.79); and the MMRd group showed significantly worse OS (HR 1.30, 95% CI: 1.11-1.53) and PFS (HR 1.27, 95% CI: 1.01-1.59). The POLEmut group, in contrast, showed similar survival as the p53wt group.

Conclusions: The four mutational profiles for patients with endometrial carcinoma in the Cancer Genome Atlas for Endometrial Cancer are associated with worse to better survival in the trend: p53abn < MMRd < POLEmut ≈ p53wt. Mutational profiling may be useful for stratifying endometrial carcinoma patients by survival risk, which in turn may improve their management.