The Value Of The Application Of Molecular Classification In Endometrial Carcinoma

Objective: The main purpose of this article is to investigate the progress of molecular classification in endometrial carcinoma,so as to explore its clinical application value,and to provide the diagnosis and treatment of endometrial carcinoma with theoretical basis.Methods: 1.In the first part:(1)Databases(before November 2018.11)will be systematically searched.(2)Title,abstract and full text which were found will be screened.(3)Data will be extracted from the included literatures.(4)The combined Hazard Ratio(HR)and Odds Ratio(OR)of 95%Confidence Interval(CI)were calculated by statistical software.2.In the second part:(1)The clinical characteristic of 95 patients with endometrial carcinoma who were operated in our hospital from 2012 to 2017 were collected.(2)The wax blocks of the patients were collected for p53 and Mismatch repair(MMR)protein immunohistochemistry(IHC).(3)According to the results of IHC,the patients were divided into four groups.(3)The overall survival(OS)and the differences of clinicopathological features among each group were analyzed.3.In the third part:(1)On the basis of the second part,the wax blocks of patients were collected and sequenced by POLE.(2)Patients were classified into four groups according to the molecular classification of Pro Mis E.(3)Statistical analysis was carried out to observe the differences in prognosis and clinicopathological features among the groups.Results: 1.In the first part:(1)A total of 6 articles were included,including 179 endometrial carcinoma patients with POLE mutation.(2)Compared with patients with non-POLE mutations,patients with POLE mutations had longer OS and longer PFS.(3)The possibility of POLE mutation in endometrial cancer patients with FIGO I stage was higher than that in patients with FIGO II-IV stage.2.In the second part:(1)There were significant differences in histological type and tumor grade among the four groups.(2)Four survival curves with different prognosis could be obtained after the combined detection of p53 and MMR.However,in COX multivariate analysis,the effect of grouping on prognosis was not statistically significant.3.In the third part:(1)71 of the 95 patients finally met the criteria.(2)There were significant differences in age,histological type,FIGO stage and tumor grade among the four groups.(3)Four survival curves with different prognosis could be obtained after grouping.(4)Most of the patients(89.6%)have received adjuvant treatment according to their high-risk factors,which may be overtreated.Conclusions: 1.In the first part:(1)The prognosis of POLE mutation endometrial carcinoma is better than that of non-POLE mutation endometrial carcinoma.(2)Patients in FIGO I are more likely to have POLE mutation.Therefore,patients can perform POLE sequencing according to this feature in order to reduce unnecessary "overtreatment" in clinical practice.2.In the second part:(1)The endometrial carcinoma patients were divided into four different prognostic curves by combined detection of p53 and MMR.(2)However,COX multivariate analysis showed that grouping had no significant effect on OS.The simplified method of large sample multicenter data verification is needed.3.In the third part:(1)Pro Mis E typing can classify most of the patients with endometrial carcinoma and divide them into four subgroups with different prognosis.(2)Most of the patients were treated with adjuvant therapy after the operation,which suggested that there may be "over-treatment" in clinical practice.(3)Patients with two molecular characteristics are still a challenge to overcome,and a large number of samples still need to be collected and analyzed.4.General conclusion.Pro Mis E molecular classification can individualize the management of patients with endometrial cancer at the first time,improve the life quality of patients,also,the requirements for samples are not high.However,at present,POLE sequencing is the only way to detect POLE mutation,and the sequencing technology is not applicable for its high cost and professional operation and analysis.So how to improve the clinical applicability of molecular typing is the most important problem now.The investigation of sensitive immunotherapeutic drugs among four groups and the solution of patients with multiple molecular features are the necessary and difficult respects of molecular classification in the future.