The TCGA Molecular Classification of Endometrial Cancer and Its Possible Impact on Adjuvant Treatment Decisions

Abstract

Adjuvant treatment decisions for endometrial cancer (EC) are based on stage, the histological grade of differentiation, histological subtype, and few histopathological markers. The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) identified four risk groups of EC patients using a combination of immunohistochemistry and mutation analysis: Polymerase Epsilon exonuclease domain mutated (POLE EDM), mismatch repair deficient (MMRd), p53 wild-type/copy-number-low (p53 wt), and p53-mutated/copy-number-high (p53 abn). Patients allocated to the POLE or abnormal p53 expression subtype are faced with a significantly altered outcome possibly requiring a modified adjuvant treatment decision. Within this review, we summarize the development of ProMisE, characterize the four molecular subtypes, and finally discuss its value in terms of a patient-tailored therapy in order to prevent significant under or overtreatment.

Keywords: brachytherapy; endometrial cancer; endometrial carcinoma; radiobiology; radiotherapy; uterine cancer; uterine carcinoma.

Figure 1

The Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) Algorithm to assess a new endometrial cancer sample. First, mismatch-repair (MMR)-deficiency is evaluated with immunohistochemistry (IHC) against MSH 6 and PMS2 proteins. Second, the Polymerase Epsilon (POLE) exonuclease domain is tested by sequencing exons 9–14. Lastly, IHC for p53 is performed to determine patients with normal expression (IHC score 1+) versus complete loss/null (IHC score 0) or accumulation (IHC score 2+). Reproduced with permission from [31].