AUTHOR=Nero Camilla , Ciccarone Francesca , Pietragalla Antonella , Duranti Simona , Daniele Gennaro , Scambia Giovanni , Lorusso Domenica 

TITLE=Adjuvant Treatment Recommendations in Early-Stage Endometrial Cancer: What Changes With the Introduction of The Integrated Molecular-Based Risk Assessment

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.612450

DOI=10.3389/fonc.2021.612450

ISSN=2234-943X

ABSTRACT=Adjuvant therapy recommendations for endometrial cancer were historically based on the individual
patient's risk of disease recurrence using clinico-pathologic factors such as age, stage, histologic
subtype, tumor grade, and lymphovascular space invasion. Despite the excellent prognosis for early
stages, considerable under and over treatment remains.
Integrated genomic characterization by The Cancer Genome Atlas (TCGA) in 2013 defined four
distinct endometrial cancer subgroups (POLE mutated, microsatellite instability, low copy number
and high copy number) with possible prognostic value.
The validation of surrogate markers (p53, microsatellite instability and POLE) to determine these
subgroups and the addition of other molecular prognosticators (CTNNB1, L1CAM) resulted in a
practical and clinically useful molecular classification tool.
The incorporation of such molecular alterations into established clinic pathologic risk factors results
in a refined improved risk assessment. Thus, the ESGO/ESTRO/ESP consensus in 2020 defined for
the first time different prognostic risk groups integrating molecular markers.
Finally, the feasibility and clinical utility of molecular profiling for tailoring adjuvant therapy in the
high-intermediate risk group is currently under investigation (NCT03469674).