Synapse - Risk stratification of stage I grade 3 endometrioid endometrial carcinoma in the era of molecular classification

Risk stratification of stage I grade 3 endometrioid endometrial carcinoma in the era of molecular classification Journal Article

Authors:	Zammarrelli, W. A. 3rd; Kim, S. H.; Da Cruz Paula, A.; Rios-Doria, E. V.; Ehmann, S.; Yeoshoua, E.; Hanlon, E. J.; Zhou, Q.; Iasonos, A.; Alektiar, K. M.; Aghajanian, C.; Makker, V.; Leitao, M. M. Jr; Abu-Rustum, N. R.; Ellenson, L. H.; Weigelt, B.; Mueller, J. J.
Article Title:	Risk stratification of stage I grade 3 endometrioid endometrial carcinoma in the era of molecular classification
Abstract:	PURPOSE The role of adjuvant therapy in stage I grade 3 endometrioid endometrial carcinoma (EEC) is debatable. We sought to define the agreement between Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) high-intermediate risk (HIR) and Gynecologic Oncology Group (GOG)-99 HIR criteria, assess their concordance with The Cancer Genome Atlas molecular subtypes, and evaluate oncologic outcomes in this population. METHODS We identified patients with stage I grade 3 EECs who underwent surgical staging at our institution from January 2014 to January 2020. Patients were stratified into PORTEC-1 HIR, GOG-99 HIR, and The Cancer Genome Atlas molecular subtypes. Adjuvant treatment, and progression-free survival (PFS), and overall survival (OS) were analyzed. RESULTS Seventy-five patients were included. The agreement between PORTEC-1 and GOG-99 HIR classification was 68% (95% CI, 56.2 to 78.3), with a kappa of 0.36 (P =.001). There was no agreement between PORTEC-1 or GOG-99 HIR classification and a dichotomized molecular classification (copy number-high [CNH] v other subtypes), with a kappa of 0.03 (P =.39) and -0.03 (P =.601), respectively. There was no difference in PFS between PORTEC-1 HIR and non-HIR (HR, 10.9; 95% CI, 0.28 to 4.21) or between GOG-99 HIR and non-HIR (HR, 1.22; 95% CI, 0.32 to 4.6) stage I grade 3 EECs. Patients with CN-H compared with non-CN-H EEC had worse PFS (HR, 5.67; 95% CI, 1.73 to 18.63) and OS (HR, 5.05; 95% CI, 1.13 to 22.5). CONCLUSION In surgically staged patients with stage I grade 3 EEC, PORTEC-1 and GOG-99 HIR criteria were not prognostic and did not identify CN-H patients. Patients with CN-H EEC had worse PFS and OS compared with those with other molecular subtypes. The integration of the molecular classification with recognized clinicopathologic factors may identify patients with higher-risk stage I grade 3 EEC who benefit from additional therapy.
Keywords:	adenocarcinoma; recurrence; diagnosis; surgery; therapy; pelvic radiation; cancer
Journal Title:	JCO Precision Oncology
Volume:	6
ISSN:	2473-4284
Publisher:	American Society of Clinical Oncology
Date Published:	2022-01-01
Start Page:	e2200194
Language:	English
ACCESSION:	WOS:000975488400075
DOI:	10.1200/po.22.00194
PROVIDER:	wos
PMCID:	PMC9616646
PUBMED:	36240474
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding author is MSK author Jennifer J. Mueller -- Source: Wos