Endometrial carcinoma (EC) is the most frequent gynecological cancer, with an increasing incidence and mortality in recent times. The last decade has represented a true revolution with the development of the integrated histo-molecular classification of EC, which allows for the stratification of patients with morphologically indistinguishable disease into groups with different prognoses. Particularly, the POLE-mutated subgroup exhibits outstanding survival. Nevertheless, the indiscriminate application of molecular classification appears premature. Its prognostic significance has been proven mainly in endometrioid EC, the most common histotype, but it has yet to be convincingly confirmed in the other minor histotypes, which indeed account for a relevant proportion of EC mortality. Moreover, its daily use both requires a mindful pathologist who is able to correctly evaluate and unambiguously report immunohistochemical staining used as a surrogated diagnostic tool and is hampered by the unavailability ofPOLEmutation analysis. Further molecular characterization of ECs is needed to allow for the identification of better-tailored therapies in different settings, as well as the safe avoidance of surgery for fertility preservation. Hopefully, the numerous ongoing clinical trials in the adjuvant and metastatic settings of EC will likely produce evidence to refine the histo-molecular classification and therapeutic guidelines. Our review aims to retrace the origin and evolution of the molecular classification for EC, reveal its strengths and limitations, show clinical relevance, and uncover the desired future developments.
子宫内膜癌（EC）是最常见的妇科恶性肿瘤，近年来其发病率和死亡率呈上升趋势。过去十年间，随着EC整合组织分子分类体系的发展，该领域实现了真正的变革——这一分类体系能够将形态学难以区分的患者划分为不同预后亚群。其中，POLE突变亚型展现出卓越的生存优势。然而，分子分类的普适性应用仍为时过早。其预后价值主要在最常见组织学类型（子宫内膜样癌）中得到验证，但在其他占比虽小却构成EC死亡重要组成部分的少见组织学类型中，尚未获得令人信服的证实。此外，该分类体系的日常应用既需要病理医师具备精准评估并明确报告免疫组化染色（作为替代诊断工具）的能力，又受限于POLE突变检测的可及性不足。未来需进一步深化EC的分子特征研究，以实现在不同临床场景中制定更精准的治疗方案，并为保留生育功能者安全规避手术提供依据。值得期待的是，目前EC辅助治疗与转移治疗领域的大量临床试验，有望为完善组织分子分类体系及治疗指南提供新证据。本文旨在追溯EC分子分类体系的起源与演进，揭示其优势与局限，阐明临床相关性，并展望未来发展方向。
肿瘤(癌症)患者之家