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Article

Prognosis Stratification Tools in Early-Stage Endometrial Cancer: Could We Improve Their Accuracy?

1
Department of Medical Oncology, Hospital Universitario La Paz, 28046 Madrid, Spain
2
Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
3
Translational Oncology Research Laboratory, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain
4
Center for Biomedical Research in the Cancer Network (Centro de Investigación Biomédica en Red de Cáncer, CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain
5
Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland
6
Molecular Pathology and Therapeutic Targets Group, Hospital La Paz Institute for Health Research (IdiPAZ), 28046 Madrid, Spain
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Cátedra UAM-ANGEM, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
8
Department of Obstetrics & Gynaecology, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain
9
Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
*
Authors to whom correspondence should be addressed.
Current address: Department of Medical Oncology, Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain.
These authors contributed equally to this work.
§
Current address: Department of Pathology, Hospital Ramón y Cajal, IRYCIS, 28034 Madrid, Spain.
Academic Editors: Pierandrea De Iaco and Anna Myriam Perrone
Cancers 2022, 14(4), 912; https://doi.org/10.3390/cancers14040912
Received: 31 December 2021 / Revised: 7 February 2022 / Accepted: 8 February 2022 / Published: 12 February 2022
(This article belongs to the Special Issue Endometrial Cancer: Old Questions and New Perspectives)
Endometrial cancer is the most common gynaecological malignancy in developed countries. Most cases are diagnosed at a localized stage, overall with a good prognosis, although approximately 15% of them will recur. The identification of patients with an increased risk of relapse remains a challenge for clinicians. There are well-defined clinicopathological characteristics associated with prognosis. These variables have been integrated in multiple classifiers to stratify the prognosis, and more recently, molecular features have also been considered. The aim of our retrospective study was to compare the three available prognostic stratification tools for endometrial cancer and determine if additional biomarkers could improve their accuracy. We confirmed that the incorporation of molecular classification in risk stratification resulted in better discriminatory capability, which was improved even further with the addition of CTNNB1 mutational evaluation.
There are three prognostic stratification tools used for endometrial cancer: ESMO-ESGO-ESTRO 2016, ProMisE, and ESGO-ESTRO-ESP 2020. However, these methods are not sufficiently accurate to address prognosis. The aim of this study was to investigate whether the integration of molecular classification and other biomarkers could be used to improve the prognosis stratification in early-stage endometrial cancer. Relapse-free and overall survival of each classifier were analyzed, and the c-index was employed to assess accuracy. Other biomarkers were explored to improve the precision of risk classifiers. We analyzed 293 patients. A comparison between the three classifiers showed an improved accuracy in ESGO-ESTRO-ESP 2020 when RFS was evaluated (c-index = 0.78), although we did not find broad differences between intermediate prognostic groups. Prognosis of these patients was better stratified with the incorporation of CTNNB1 status to the 2020 classifier (c-index 0.81), with statistically significant and clinically relevant differences in 5-year RFS: 93.9% for low risk, 79.1% for intermediate merged group/CTNNB1 wild type, and 42.7% for high risk (including patients with CTNNB1 mutation). The incorporation of molecular classification in risk stratification resulted in better discriminatory capability, which could be improved even further with the addition of CTNNB1 mutational evaluation. View Full-Text
Keywords: endometrial cancer; prognosis; risk assessment; biomarkers; CTNNB1 endometrial cancer; prognosis; risk assessment; biomarkers; CTNNB1
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MDPI and ACS Style

Ramon-Patino, J.L.; Ruz-Caracuel, I.; Heredia-Soto, V.; Garcia de la Calle, L.E.; Zagidullin, B.; Wang, Y.; Berjon, A.; Lopez-Janeiro, A.; Miguel, M.; Escudero, J.; Gallego, A.; Castelo, B.; Yebenes, L.; Hernandez, A.; Feliu, J.; Pelaez-García, A.; Tang, J.; Hardisson, D.; Mendiola, M.; Redondo, A. Prognosis Stratification Tools in Early-Stage Endometrial Cancer: Could We Improve Their Accuracy? Cancers 2022, 14, 912. https://doi.org/10.3390/cancers14040912

AMA Style

Ramon-Patino JL, Ruz-Caracuel I, Heredia-Soto V, Garcia de la Calle LE, Zagidullin B, Wang Y, Berjon A, Lopez-Janeiro A, Miguel M, Escudero J, Gallego A, Castelo B, Yebenes L, Hernandez A, Feliu J, Pelaez-García A, Tang J, Hardisson D, Mendiola M, Redondo A. Prognosis Stratification Tools in Early-Stage Endometrial Cancer: Could We Improve Their Accuracy? Cancers. 2022; 14(4):912. https://doi.org/10.3390/cancers14040912

Chicago/Turabian Style

Ramon-Patino, Jorge Luis, Ignacio Ruz-Caracuel, Victoria Heredia-Soto, Luis Eduardo Garcia de la Calle, Bulat Zagidullin, Yinyin Wang, Alberto Berjon, Alvaro Lopez-Janeiro, Maria Miguel, Javier Escudero, Alejandro Gallego, Beatriz Castelo, Laura Yebenes, Alicia Hernandez, Jaime Feliu, Alberto Pelaez-García, Jing Tang, David Hardisson, Marta Mendiola, and Andres Redondo. 2022. "Prognosis Stratification Tools in Early-Stage Endometrial Cancer: Could We Improve Their Accuracy?" Cancers 14, no. 4: 912. https://doi.org/10.3390/cancers14040912

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