Background
Patients younger than 40 years usually present with early-stage endometrial cancer
with favorable prognosis. However, such patients are usually in their childbearing
age and may desire fertility-sparing options. The identification of biomarkers may
improve the clinical outcomes in these patients and aid in fertility-sparing management;
however, there has been no reports on biomarker analysis so far.
Objective
This study aimed to evaluate the prognostic significance of Proactive Molecular Risk
Classifier for Endometrial Cancer in the fertility-sparing management of endometrial
cancer.
Study Design
A total of 57 endometrial biopsy specimens obtained before hormone therapy were evaluated,
and patients were classified according to the Proactive Molecular Risk Classifier
for Endometrial Cancer molecular subtypes (mismatch repair deficiency, DNA polymerase
epsilon mutation, wild-type p53, and abnormal p53). The primary endpoint was the response
rate after hormone therapy. The secondary endpoint was the recurrence rate after the
complete response, hysterectomy rate owing to treatment failure, and upstaged diagnosis
rate after hysterectomy.
Results
Of 57 patients, 9 (15.8%) had mismatch repair deficiency, 2 (3.5%) had DNA polymerase
epsilon mutation, 45 (78.9%) had wild-type p53, and 1 (1.8%) had abnormal p53. Overall,
the complete response rate was 75.4% after hormone therapy. Patients with mismatch
repair deficiency had a significantly lower complete response or partial response
rate than those with wild-type p53 in terms of the best overall response (44.4% [95%
confidence interval, 4.0–85.0] vs 82.2% [95% confidence interval, 71.0–94.0]; P=.018) and complete response rate at 6 months (11.1% [95% confidence interval, 0.2–37.0]
vs 53.3% [95% confidence interval, 38.0–68.0]; P=.010). Among patients with mismatch repair deficiency, 4 underwent immediate hysterectomy
because of treatment failure and 3 presented upstaged diagnosis after hysterectomy.
Conclusion
The Proactive Molecular Risk Classifier for Endometrial Cancer molecular classification
has prognostic significance in the fertility-sparing management of endometrial cancer,
thereby enabling early stratification and risk assignment to direct care. Mismatch
repair status could be used as a predictive biomarker for selecting patients who could
benefit from hormone therapy. These findings need to be validated in larger studies.
Key words
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Article info
Publication history
Published online: October 08, 2020
Accepted:
October 2,
2020
Received in revised form:
September 25,
2020
Received:
July 26,
2020
Footnotes
The authors report no conflict of interest.
This research was supported by a grant of the Korea Health Technology Research and Development Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare of South Korea (grant number, HI19C0263).
Cite this article as: Chung YS, Woo HY, Lee JY, et al. Mismatch repair status influences response to fertility-sparing treatment of endometrial cancer. Am J Obstet Gynecol 2021;224:370.e1-13.
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