文章：

多分类器子宫内膜癌的临床病理特征与风险分层：一项来自波兰的多中心研究

Clinicopathological Features and Risk Stratification of Multiple-Classifier Endometrial Cancers: A Multicenter Study from Poland

原文发布日期：28 July 2025

DOI: 10.3390/cancers17152483

类型: Article

开放获取: 是

英文摘要：

Rationale:The ProMisE molecular classification improves risk assessment in endometrial cancer (EC), but 3–11% of cases exhibit overlapping molecular features, complicating clinical decisions. We analyzed the prevalence and clinicopathological profiles of multiple-classifier ECs in a large Polish cohort.Methods:In this retrospective study (2022–2025), 1075 ECs from four institutions were classified by MMR and p53 immunohistochemistry and POLE exon sequencing. Tumors showing ≥2 molecular features (e.g., MMRd–p53abn, POLEmut–p53abn) were categorized as multiple-classifier ECs.Results:Multiple-classifier ECs comprised 6.9% (74/1075), with MMRd–p53abn (3.9%) being most common. These tumors exhibited more aggressive features vs. MMRd-only: G3 (28.57% vs. 11.79%,p= 0.002), non-endometrioid histology (11.9% vs. 2.85%,p= 0.018), and high–intermediate/high-risk (HIR/HR) groups (59.52% vs. 37.80%,p= 0.001). POLEmut–p53abn (N = 4) and POLEmut–MMRd–p53abn (N = 10) tumors showed advanced stages (75% and 40% FIGO III–IV, respectively), in contrast to classical POLEmut tumors (6.7% FIGO III–IV), and higher rates of nodal metastases.Conclusions:Co-occurrence of molecular classifiers, including triple-classifier tumors, correlates with more adverse profiles and may undermine current stratification paradigms. This study emphasizes the need to further investigate and refine molecular risk models to account for overlapping profiles.

摘要翻译： 

背景：ProMisE分子分型改善了子宫内膜癌（EC）的风险评估，但3–11%的病例表现出重叠的分子特征，使临床决策复杂化。我们在一个大型波兰队列中分析了多重分类器子宫内膜癌的患病率及临床病理特征。 方法：在这项回顾性研究（2022–2025年）中，通过MMR和p53免疫组化检测及POLE外显子测序，对来自四家机构的1075例子宫内膜癌进行了分类。显示≥2种分子特征（如MMRd–p53abn、POLEmut–p53abn）的肿瘤被归类为多重分类器子宫内膜癌。 结果：多重分类器子宫内膜癌占6.9%（74/1075），其中MMRd–p53abn（3.9%）最为常见。与仅MMRd的肿瘤相比，这些肿瘤表现出更具侵袭性的特征：G3分级（28.57% vs. 11.79%，p=0.002）、非子宫内膜样组织学类型（11.9% vs. 2.85%，p=0.018）以及中高危/高危（HIR/HR）组别（59.52% vs. 37.80%，p=0.001）。POLEmut–p53abn（N=4）和POLEmut–MMRd–p53abn（N=10）肿瘤显示出更晚分期（分别为75%和40%为FIGO III–IV期，而经典POLEmut肿瘤为6.7% FIGO III–IV期）以及更高的淋巴结转移率。 结论：分子分类器的共存（包括三重分类器肿瘤）与更不良的临床病理特征相关，并可能削弱当前的风险分层范式。本研究强调需要进一步研究和完善分子风险模型，以纳入重叠的分子特征。

原文链接：

Clinicopathological Features and Risk Stratification of Multiple-Classifier Endometrial Cancers: A Multicenter Study from Poland