Background/Objectives: Prognostic assessment in endometrial cancer (EC) is based on clinical and pathological features such as histological type, FIGO stage, tumor grade, LVSI, P53 status, and hormone receptor expression. Recent molecular research has distinguished four EC subtypes, with MMR status (pMMR vs. dMMR) providing clinically relevant stratification due to its predictive value for immunotherapy. The present study aims to compare dMMR and pMMR tumors in terms of the prevalence of adverse histopathological prognostic factors.Methods: This retrospective study included 179 patients with endometrioid endometrial carcinoma (EEC) treated at the authors’ institution (1 January 2023–31 August 2025). Patients were classified by MMR status (pMMR vs. dMMR) based on immunohistochemistry, and clinicopathological variables, including FIGO stage, myometrial invasion depth, tumor grade, LVSI, ER/PR expression, and P53 status, were analyzed. Normality was assessed using the Shapiro–Wilk test. Categorical variables were tested with chi-square or Fisher’s exact tests, reporting odds ratios with 95% CI, while continuous variables were compared using the Mann–Whitney test and presented as median (IQR) with the Hodges–Lehmann difference and 95% CI. Multivariable logistic regression with Wald tests was performed.Results: dMMR tumors accounted for 29.05% of all cases. Patients in the dMMR group were significantly more likely to present with FIGO stage III/IV disease (p= 0.036) and to exhibit LVSI (p= 0.008). No differences were observed between the groups with respect to tumor grade, estrogen receptor positivity, progesterone receptor positivity, or the prevalence of deep myometrial invasion. The most frequent pattern of protein loss in the dMMR population was concurrent loss of MLH1 and PMS2.Conclusions: In the studied population, dMMR tumors more frequently exhibited adverse prognostic features of EC, such as advanced stage of disease and lymphovascular space invasion. This suggests the potential for effective immunotherapy in this patient group.
背景/目的：子宫内膜癌（EC）的预后评估主要依据组织学类型、FIGO分期、肿瘤分级、淋巴血管间隙浸润（LVSI）、P53状态及激素受体表达等临床病理特征。近期分子研究将EC区分为四种亚型，其中错配修复（MMR）状态（pMMR与dMMR）因对免疫治疗的预测价值而具有临床分层意义。本研究旨在比较dMMR与pMMR肿瘤在不良组织病理学预后因素发生率方面的差异。 方法：本回顾性研究纳入179例于作者所在机构（2023年1月1日至2025年8月31日期间）接受治疗的子宫内膜样腺癌（EEC）患者。通过免疫组化检测确定MMR状态（pMMR vs. dMMR）并进行分组，分析包括FIGO分期、肌层浸润深度、肿瘤分级、LVSI、ER/PR表达及P53状态在内的临床病理变量。采用Shapiro-Wilk检验评估数据正态性。分类变量使用卡方检验或Fisher精确检验，报告比值比及95%置信区间；连续变量采用Mann-Whitney检验，以中位数（四分位距）呈现，并计算Hodges-Lehmann差异及95%置信区间。采用Wald检验进行多变量逻辑回归分析。 结果：dMMR肿瘤占全部病例的29.05%。dMMR组患者出现FIGO III/IV期疾病（p=0.036）及LVSI（p=0.008）的比例显著更高。两组在肿瘤分级、雌激素受体阳性率、孕激素受体阳性率及深肌层浸润发生率方面均无显著差异。dMMR人群中最常见的蛋白缺失模式为MLH1与PMS2共缺失。 结论：在研究人群中，dMMR肿瘤更频繁地表现出EC的不良预后特征，如晚期疾病分期和淋巴血管间隙浸润。这提示该患者群体可能从免疫治疗中获益。
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