少即是多?在子宫内膜癌分子分类中比较基因组剖析和免疫组化模型:多中心、回顾性、倾向匹配生存分析。

IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY Gynecologic oncology Pub Date : 2024-10-17 DOI:10.1016/j.ygyno.2024.10.010
Emanuele Perrone, Ilaria Capasso, Diana Giannarelli, Rita Trozzi, Luigi Congedo, Elisa Ervas, Vincenzo Tarantino, Giovanni Esposito, Luca Palmieri, Arianna Guaita, Anne-Sophie van Rompuy, Giulia Scaglione, Gian Franco Zannoni, Giovanni Scambia, Frédéric Amant, Francesco Fanfani
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引用次数: 0

摘要

背景:基于基因组图谱的模型(GP-M)是子宫内膜癌(EC)分子分类的黄金标准,但在低收入环境中,与基因组测序可用性相关的几个问题依然存在,而且管理中的健康差异正在增加。本研究旨在探讨免疫组化单独模式与基于基因组图谱的标准模式相比,在对子宫内膜癌进行分类时在肿瘤治疗效果方面的非劣效性:方法:回顾性纳入所有术前接受手术分期的子宫内膜癌患者。根据 IHC-M 对患者进行分层:MMRp、p53野生型(p53wt)和雌激素受体(ER)阳性;2)MMRp、p53wt和ER阴性;3)MMRd;4)p53abn。IHC-M和GP-M队列之间进行了病例对照比较。然后,进行倾向匹配分析:根据IHC-M分类的EC患者与根据GP-M分类的患者按3:1的比例进行匹配:结果:共纳入1587名EC患者。无病生存期和总生存期的 Kaplan-Meier 生存曲线显示,这两种模型在对研究人群进行风险分级时表现相似(p 结论:IHC-M 与 GP-M 的分级结果存在重叠:与 GP-M 相比,IHC-M 在肿瘤结果方面显示出重叠的分类性能。本研究可为进一步研究 POLE 测序在分子分级中的实际临床影响,以及ER 状态在进一步将 EC 患者划分为不同风险等级时的潜在独立预后作用奠定基础。
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Less is more? Comparison between genomic profiling and immunohistochemistry-based models in endometrial cancer molecular classification: A multicenter, retrospective, propensity-matched survival analysis.

Background: Genomic profiling-based model (GP-M) is the gold-standard for endometrial cancer (EC) molecular classification, but several issues related to the availability of genomic sequencing in low-income settings remain and health disparities in the management are increasing. This study aims to investigate the non-inferiority of the immunohistochemistry-alone model in classifying ECs compared to the standard genomic profiling-based model in terms of oncologic outcomes.

Methods: All preoperative uterine-confined ECs undergoing surgical staging were retrospectively included. Patients classified by IHC-M were stratified into: MMR-proficient (MMRp), p53 wild type (p53wt) and estrogen receptor (ER) positive, 2) MMRp, p53wt and ER-negative, 3) MMRd, and 4) p53abn. A case-control comparison was performed between the IHC-M and GP-M cohorts. Then, a propensity-matched analysis was performed: ECs classified by IHC-M were matched in a 3:1 ratio with patients classified by GP-M.

Results: 1587 patients with EC were included. The Kaplan-Meier survival curves for disease-free survival and overall survival demonstrated that the two models performed similarly in risk-stratifying the study population (p < 0.0001). Moreover, the AUC-ROC showed overlapping results: 0.77 (0.66-0.87) for IHC-M and 0.72 (0.63-0.81) for GP-M, indicating that both models were able to successfully identify patients at high-risk and low-risk of disease recurrence/progression.

Conclusion: The IHC-M showed overlapping classification performance compared to the GP-M in terms of oncologic outcomes. This study may lay the basis to further investigate the real-life clinical impact of POLE sequencing in molecular classification and the potential stand-alone prognostic role of ER status for further allocation of EC patients into risk classes.

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来源期刊
Gynecologic oncology
Gynecologic oncology 医学-妇产科学
CiteScore
8.60
自引率
6.40%
发文量
1062
审稿时长
37 days
期刊介绍: Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy
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