Effect Of ProMisE Molecular Classification Combined With Clinicopathologic Parameters On Prognosis Of Endometrial Carcinoma

Objective: To investigate the molecular typing and clinicopathological features of ProMisE in endometrial cancer and its impact on the prognosis of patients with endometrial cancer.Methods: A retrospective study was used to collect the clinicopathological data of81 patients admitted to Sichuan Cancer Hospital for endometrial cancer surgery between December 2019 and February 2021,to determine the ProMisE molecular subtypes of patients based on their MMR status,p53 immunohistochemistry results,and POLE gene Sanger generation sequencing results,and to detect the correlations of ProMisE molecular subtypes with demographic and pathological variables were examined by non-parametric tests.The Kappa consistency test was used to cross-tabulate the concordance between ProMisE molecular typing and 2016 ESMO conventional clinicopathological risk stratification.The 2-year OS and PFS survival curves of ProMisE molecular typing,ESMO clinicopathological risk stratification,and each clinicopathological parameter were plotted separately and log-rank tests were performed to investigate the effects of different clinicopathological characteristics,molecular typing,and ESMO risk stratification factors on the prognosis of endometrial cancer patients,and Harell’s C index was calculated to the Harell’s C index was calculated to compare the predictive ability of ProMisE molecular typing,ESMO risk stratification and ESGO-ESTRO-ESP risk stratification model of ProMisE molecular typing combined with clinicopathological parameters on OS and PFS of endometrial cancer patients.Results: The median age of 81 patients with endometrial cancer was 54 years(range:33-77 years),and a total of 43 cases(53.1%)of MMRD,3 cases(3.7%)of POLE EDM,16 cases(19.8%)of p53 abn,and 19 cases(23.5%)of p53 wt were identified by ProMisE molecular typing.ProMisE molecular typing and ESMO traditional clinicopathological risk stratification system was poorly consistent(Kappa=0.005,p=0.922),and patients in each ESMO risk group were present in all ProMisE subgroups,with no statistically significant differences.No statistically significant differences were found between the four ProMisE molecular typing for age,ascites cytology,LVSI,tumor diameter,myometrial invasion,BMI,type of pathology,grade of tumor,and stage(all p>0.05).Univariate analysis showed that p53 abn type,late stage,positive ascites cytology,and non-endometrioid adenocarcinoma pathological type were significantly associated with decreased OS in endometrial cancer(all p<0.05).Patients with advanced staging,positive ascites cytology,pathological type of non-endometrioid adenocarcinoma,cervical interstitial invasion,adnexal metastasis,and high risk of ESMO risk stratification were significantly associated with decreased PFS in endometrial cancer(all p<0.05).Multivariate Cox regression analysis revealed that positive ascites cytology(HR=19.471,p=0.001)and cervical interstitial invasion(HR=9.662,p=0.032)were independent prognostic influences for decreased PFS,and positive ascites cytology(HR=20.641,p=0.012)was also an independent prognostic influence for OS in endometrial cancer.Further analysis yielded a statistically significant correlation between ascites cytology and stage(p=0.025).For the predictive power of OS and PFS,the ESGO-ESTRO-ESP model Harell’s C index,which combines molecular typing and clinicopathological parameters,was superior to the other two models.ESGO-ESTRO-ESP model and ESMO2016 model compared to the ProMisE model for PFS with a statistically better predictive ability(p<0.05).Conclusion: There was no statistically significant correlation between ProMisE molecular typing and clinicopathological parameters,but this may be related to the small number of clinical cases of patients enrolled in this study and needs to be confirmed in large clinical trials.ProMisE molecular typing did not agree well with the traditional clinicopathological risk stratification system of ESMO,and patients in all risk groups of ESMO were present in all ProMisE subgroups.The ESGO-ESTRO-ESP prognostic stratification model,is more capable of predicting OS and PFS in patients.Positive ascites cytology was an independent prognostic influence on OS survival,and ascites cytology and cervical interstitial invasion were independent prognostic influences on PFS.Positive ascites cytology was significantly correlated with late postoperative staging.Studies have shown that combining molecular staging with clinicopathological parameters can improve the prognosis of patients with endometrial cancer and provide individualized treatment plans for patients.Cytology of ascites should be routinely sent for examination,pending verification of its impact on survival prognosis of endometrial cancer through large-scale prospective clinical trials to guide our clinical treatment.