Shiyi Peng , Ying Zheng , Jianhong Liu , Sijing Chen , Kaixuan Yang , Wei Wang , Gang Ning , Xiao Tang , Lei Li , Zhijun Ye , Yunwei Ouyang , Zhongying Huang , Qianhong Ma , Fan Yang , Aiyun Xing , Yuedong He , Ping Wang , Xiaoyun Yang , Zhilan Peng
{"title":"早期子宫内膜癌保胎治疗中的分子分类：优化患者选择的潜在工具","authors":"Shiyi Peng , Ying Zheng , Jianhong Liu , Sijing Chen , Kaixuan Yang , Wei Wang , Gang Ning , Xiao Tang , Lei Li , Zhijun Ye , Yunwei Ouyang , Zhongying Huang , Qianhong Ma , Fan Yang , Aiyun Xing , Yuedong He , Ping Wang , Xiaoyun Yang , Zhilan Peng","doi":"10.1016/j.ygyno.2024.10.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the prognostic significance of molecular classification on treatment outcomes of fertility-sparing treatment (FST) in early-stage endometrial cancer (EC), and its potential in optimizing fertility-sparing management.</div></div><div><h3>Methods</h3><div>Patients with early-stage EC who received FST with ProMisE classification were investigated. Oncological and reproductive outcomes were compared across four molecular subtypes. Factors influencing complete response (CR) were analyzed.</div></div><div><h3>Results</h3><div>Among 116 molecularly classified patients, 80 were evaluated for therapeutic effects, including 64 (80.0 %) p53wt, 7 (8.7 %) MMR-D, 5 (6.3 %) POLE EDM, and 4 (5.0 %) p53abn. Overall CR rates were comparable across four molecular subtypes, with 92.2 % of p53wt, 71.4 % of MMR-D, 100.0 % of POLE EDM, and 75.0 % of p53abn (<em>P</em> = 0.145). MMR-D patients needed the longest median treatment time to achieve CR (7.9 months, range 3.5–15.9), while POLE EDM required the shortest (3.0 months, range 2.8–6.4), followed by p53abn (3.5 months, range 3.0–3.7) and p53wt (3.7 months, range 2.2–22.8) (<em>P</em> <em>=</em> 0.049). Among 14 p53wt patients with superficial myometrial invasion (MI) or G2 histology, 13 (92.9 %) achieved CR, and of 8 who attempted to conceive,4 delivered. Multivariable analysis identified MMR-D, superficial MI and insulin resistance negatively predicted CR, while POLE EDM was a positive factor.</div></div><div><h3>Conclusions</h3><div>Molecular classification of EC may serve as a tool for predicting response to FST and assist in identifying candidates for FST. POLE EDM patients tended to obtain promising outcomes. MMR-D cases should be cautiously administrated for FST with close surveillance. Patients with p53wt demonstrated favorable outcomes, including those with superficial MI or G2 EC. Patients with endometrium-confined p53abn tumors may benefit from FST. However, given the small sample sizes of certain subtypes, further investigation is necessary to validate these findings.</div></div>","PeriodicalId":12853,"journal":{"name":"Gynecologic oncology","volume":"191 ","pages":"Pages 240-248"},"PeriodicalIF":4.5000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Molecular classification in fertility-sparing treatment of early-stage endometrial cancer: A potential tool for optimizing patient selection\",\"authors\":\"Shiyi Peng , Ying Zheng , Jianhong Liu , Sijing Chen , Kaixuan Yang , Wei Wang , Gang Ning , Xiao Tang , Lei Li , Zhijun Ye , Yunwei Ouyang , Zhongying Huang , Qianhong Ma , Fan Yang , Aiyun Xing , Yuedong He , Ping Wang , Xiaoyun Yang , Zhilan Peng\",\"doi\":\"10.1016/j.ygyno.2024.10.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To investigate the prognostic significance of molecular classification on treatment outcomes of fertility-sparing treatment (FST) in early-stage endometrial cancer (EC), and its potential in optimizing fertility-sparing management.</div></div><div><h3>Methods</h3><div>Patients with early-stage EC who received FST with ProMisE classification were investigated. Oncological and reproductive outcomes were compared across four molecular subtypes. Factors influencing complete response (CR) were analyzed.</div></div><div><h3>Results</h3><div>Among 116 molecularly classified patients, 80 were evaluated for therapeutic effects, including 64 (80.0 %) p53wt, 7 (8.7 %) MMR-D, 5 (6.3 %) POLE EDM, and 4 (5.0 %) p53abn. Overall CR rates were comparable across four molecular subtypes, with 92.2 % of p53wt, 71.4 % of MMR-D, 100.0 % of POLE EDM, and 75.0 % of p53abn (<em>P</em> = 0.145). MMR-D patients needed the longest median treatment time to achieve CR (7.9 months, range 3.5–15.9), while POLE EDM required the shortest (3.0 months, range 2.8–6.4), followed by p53abn (3.5 months, range 3.0–3.7) and p53wt (3.7 months, range 2.2–22.8) (<em>P</em> <em>=</em> 0.049). Among 14 p53wt patients with superficial myometrial invasion (MI) or G2 histology, 13 (92.9 %) achieved CR, and of 8 who attempted to conceive,4 delivered. Multivariable analysis identified MMR-D, superficial MI and insulin resistance negatively predicted CR, while POLE EDM was a positive factor.</div></div><div><h3>Conclusions</h3><div>Molecular classification of EC may serve as a tool for predicting response to FST and assist in identifying candidates for FST. POLE EDM patients tended to obtain promising outcomes. MMR-D cases should be cautiously administrated for FST with close surveillance. Patients with p53wt demonstrated favorable outcomes, including those with superficial MI or G2 EC. Patients with endometrium-confined p53abn tumors may benefit from FST. However, given the small sample sizes of certain subtypes, further investigation is necessary to validate these findings.</div></div>\",\"PeriodicalId\":12853,\"journal\":{\"name\":\"Gynecologic oncology\",\"volume\":\"191 \",\"pages\":\"Pages 240-248\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Gynecologic oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0090825824011624\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gynecologic oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090825824011624","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Molecular classification in fertility-sparing treatment of early-stage endometrial cancer: A potential tool for optimizing patient selection
Objective
To investigate the prognostic significance of molecular classification on treatment outcomes of fertility-sparing treatment (FST) in early-stage endometrial cancer (EC), and its potential in optimizing fertility-sparing management.
Methods
Patients with early-stage EC who received FST with ProMisE classification were investigated. Oncological and reproductive outcomes were compared across four molecular subtypes. Factors influencing complete response (CR) were analyzed.
Results
Among 116 molecularly classified patients, 80 were evaluated for therapeutic effects, including 64 (80.0 %) p53wt, 7 (8.7 %) MMR-D, 5 (6.3 %) POLE EDM, and 4 (5.0 %) p53abn. Overall CR rates were comparable across four molecular subtypes, with 92.2 % of p53wt, 71.4 % of MMR-D, 100.0 % of POLE EDM, and 75.0 % of p53abn (P = 0.145). MMR-D patients needed the longest median treatment time to achieve CR (7.9 months, range 3.5–15.9), while POLE EDM required the shortest (3.0 months, range 2.8–6.4), followed by p53abn (3.5 months, range 3.0–3.7) and p53wt (3.7 months, range 2.2–22.8) (P= 0.049). Among 14 p53wt patients with superficial myometrial invasion (MI) or G2 histology, 13 (92.9 %) achieved CR, and of 8 who attempted to conceive,4 delivered. Multivariable analysis identified MMR-D, superficial MI and insulin resistance negatively predicted CR, while POLE EDM was a positive factor.
Conclusions
Molecular classification of EC may serve as a tool for predicting response to FST and assist in identifying candidates for FST. POLE EDM patients tended to obtain promising outcomes. MMR-D cases should be cautiously administrated for FST with close surveillance. Patients with p53wt demonstrated favorable outcomes, including those with superficial MI or G2 EC. Patients with endometrium-confined p53abn tumors may benefit from FST. However, given the small sample sizes of certain subtypes, further investigation is necessary to validate these findings.
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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