New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care

Abstract

Endometrial carcinoma (EC) is the fourth most common cancer in women in the developed world. Classification of ECs by histomorphologic criteria has limited reproducibility and better tools are needed to distinguish these tumors and enable a subtype-specific approach to research and clinical care. Based on the Cancer Genome Atlas, two research teams have developed pragmatic molecular classifiers that identify four prognostically distinct molecular subgroups. These methods can be applied to diagnostic specimens (e.g., endometrial biopsy) with the potential to completely change the current risk stratification systems and enable earlier informed decision making. The evolution of genomic classification in ECs is shared herein, as well as potential applications and discussion of the essential research still needed in order to optimally integrate molecular classification in to current standard of care.

Keywords: Endometrial carcinoma; Histotype; Mismatch repair deficiencies; Molecular classification; POLE mutations; Prognosis; Risk stratification; The Cancer Genome Atlas (TCGA); p53.

Fig. 1

Schematic of the a Leiden/TransPORTEC and b ProMisE/Vancouver molecular classification systems including testing performed, molecular subgroups identified, and by what criteria cases would be considered unclassifiable