Objective: To investigate The Cancer Genome Atlas (TCGA) molecular classification of endometrial cancer (EC) and endometrial atypical hyperplasia (AH) treated with fertility-sparing therapy.
Methods: A total of 46 EC and AH patients who received fertility-sparing therapy and TCGA molecular classification tested by next generation sequencing, in Peking University People¡¯s Hospital from June 2020 to December 2021, were retrospectively collected. We analyzed the relationship between molecular classification and clinicopathological factors and treatment outcomes.
Results: Of the 46 patients, including 40 EC and 6 AH patients, 70.5% (32 patients) had complete remission (CR) after treatment, with median CR time of 8 months. The cases were distributed as no specific molecular profile (NSMP; n=34, 73.9%) subtype mainly, microsatellite instability-high (MSI-H; n=7, 15.2%), POLE ultra?mutated (n=3, 6.5%), and copy number high (CNH; n=2, 4.3%). Patients with MSI-H subtype had lower body mass index (24.0¡¾5.5 kg/m2), more family history of tumor (6/7), more with loss of mismatch repair protein expression by immunohistochemical (7/7), and higher Ki67 expression level (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 such patients were less likely to achieve CR than those with NSMP subtype (p=0.022). Subgroup analysis of patients with NSMP showed that, age ¡Ã30 years and diabetes mellitus related with longer treatment time to CR (p=0.01 and p=0.059, respectively). In addition, CR was obtained in 2 (2/3) POLE ultra?mutated cases and 1 (2/2) CNH case, respectively.
Conclusion: TCGA molecular classification relates with the treatment response in patients with EC and AH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy.
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