Molecular and pathologic data to guide selection of patients with endometrioid endometrial cancer for ovarian preservation Journal Article

   


Authors: Manning-Geist, B. L.; Rios-Doria, E.; Liu, Y. L.; Ellenson, L. H.; Zhou, Q. C.; Iasonos, A.; Leitao, M. M. Jr; Abu-Rustum, N. R.; Weigelt, B.; Mueller, J. J.
Article Title: Molecular and pathologic data to guide selection of patients with endometrioid endometrial cancer for ovarian preservation
Abstract: Objectives To investigate the association of molecular and pathologic factors with concurrent or recurrent ovarian disease to guide ovarian preservation in endometrioid endometrial cancer. Methods Patients with endometrial cancer ≤50 years of age at diagnosis were grouped by elective oophorectomy versus ovarian preservation at staging (January 2010 to June 2021). Tumors were stratified by molecular sub-type and CTNNB1 mutational status with next generation sequencing and immunohistochemistry. Germline data identified patients with Lynch syndrome. Associations between molecular/pathologic features and concurrent ovarian disease in patients electing oophorectomy were compared with the Wilcoxon rank-sum and Fisher’s exact tests. Associations with isolated ovarian recurrences in patients who chose ovarian preservation were examined using survival analyses. Results Among 317 patients with endometrial cancer who underwent bilateral oophorectomy, 27 (9%) had malignant ovarian tumors, of whom 11 (41%) had no gross ovarian involvement on intra-operative survey. For patients with sequencing, concurrent malignant ovarian tumors were diagnosed in 0/14 (0%) POLE, 2/48 (4%) copy number-low/no specific molecular profile, 10/22 (45%) microsatellite instability-high, and 3/6 (50%) copy number-high/TP53abnormal patients (p<0.001). Concurrent malignant ovarian tumors were present in 1/30 (3%) hotspot CTNNB1-mutated versus 10/60 (17%) wildtype/CTNNB1 non-hotspot mutated endometrial cancer patients (p=0.11) and 7/28 (25%) Lynch versus 7/74 (9%) non-Lynch syndrome patients (p=0.06). Concurrent malignant ovarian tumors were present in patients with higher grade endometrial cancer (5% grade 1 vs 20% grade 2 and 24% grade 3; p<0.001), present versus absent lymphovascular space invasion (20% vs 6%; p=0.004), positive versus negative pelvic washings (28% vs 7%; p=0.016), and ≥50% versus <50% myoinvasion (24% vs 7%; p=0.004). Of 103 patients who chose ovarian preservation, four had isolated ovarian recurrences (two had high-risk pathologic features and two had high-risk molecular features). Conclusions The integration of molecular and pathologic data may improve risk stratification of pre-menopausal patients with endometrial cancer and enhance candidate selection for ovarian preservation. © 2024 BMJ Publishing Group. All rights reserved.
Keywords: immunohistochemistry; adult; human tissue; aged; middle aged; survival analysis; retrospective studies; human cell; major clinical study; genetics; patient selection; endometrioid carcinoma; endometrial neoplasms; endometrium cancer; ovarian neoplasms; ovariectomy; cohort analysis; pathology; retrospective study; conservative treatment; microsatellite instability; ovary tumor; beta catenin; endometrium tumor; carcinoma, endometrioid; ctnnb1 protein, human; fertility preservation; ovarian preservation; procedures; oophorectomy; high throughput sequencing; organ sparing treatments; humans; human; female; article
Journal Title: International Journal of Gynecological Cancer
Volume: 34
Issue: 5
ISSN: 1048-891X
Publisher: Lippincott Williams & Wilkins  
Date Published: 2024-05-01
Start Page: 697
End Page: 704
Language: English
DOI: 10.1136/ijgc-2023-005194
PUBMED: 38508587
PROVIDER: scopus
PMCID: PMC11081823
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85188656184&doi=10.1136%2fijgc-2023-005194&partnerID=40&md5=ddcbcdb5578da9a685c4b51eeadd0a94
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Jennifer Mueller -- Source: Scopus
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MSK Authors
  1. Mario Leitao
    575 Leitao
  2. Nadeem Abu-Rustum
    888 Abu-Rustum
  3. Qin Zhou
    253 Zhou
  4. Alexia Elia Iasonos
    362 Iasonos
  5. Britta Weigelt
    632 Weigelt
  6. Jennifer Jean Mueller
    186 Mueller
  7. Ying Liu
    105 Liu
  8. Lora Hedrick Ellenson
    108 Ellenson
  9. Eric Vincent Rios-Doria
    35 Rios-Doria
  10. Beryl Manning-Geist
    51 Manning-Geist
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