Format

Send to

Choose Destination
See comment in PubMed Commons below
Mod Pathol. 2015 Jun;28(6):836-44. doi: 10.1038/modpathol.2015.43. Epub 2015 Feb 27.

Refining prognosis and identifying targetable pathways for high-risk endometrial cancer; a TransPORTEC initiative.

Author information

1
Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
2
Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
3
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, ON, Canada.
4
Molecular and Population Genetics Laboratory, The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
5
Department of Gynecology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
6
Department of Medicine, Gynecology Unit, Gustave Roussy, Villejuif, France.
7
Institute of Cancer Sciences, University of Manchester, St Marys Hospital, Manchester, UK.
8
Department of Clinical Oncology, Barts Health NHS Trust, London, UK.
9
Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia.
10
Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.

Abstract

This study aimed to investigate whether molecular analysis can be used to refine risk assessment, direct adjuvant therapy, and identify actionable alterations in high-risk endometrial cancer. TransPORTEC, an international consortium related to the PORTEC3 trial, was established for translational research in high-risk endometrial cancer. In this explorative study, routine molecular analyses were used to detect prognostic subgroups: p53 immunohistochemistry, microsatellite instability and POLE proofreading mutation. Furthermore, DNA was analyzed for hotspot mutations in 13 additional genes (BRAF, CDKNA2, CTNNB1, FBXW7, FGFR2, FGFR3, FOXL2, HRAS, KRAS, NRAS, PIK3CA, PPP2R1A, and PTEN) and protein expression of ER, PR, PTEN, and ARID1a was analyzed. Rates of distant metastasis, recurrence-free, and overall survival were calculated using the Kaplan-Meier method and log-rank test. In total, samples of 116 high-risk endometrial cancer patients were included: 86 endometrioid; 12 serous; and 18 clear cell. For endometrioid, serous, and clear cell cancers, 5-year recurrence-free survival rates were 68%, 27%, and 50% (P=0.014) and distant metastasis rates 23%, 64%, and 50% (P=0.001), respectively. Four prognostic subgroups were identified: (1) a group of p53-mutant tumors; (2) microsatellite instable tumors; (3) POLE proofreading-mutant tumors; and (4) a group with no specific molecular profile (NSMP). In group 3 (POLE-mutant; n=14) and group 2 (microsatellite instable; n=19) patients, no distant metastasis occurred, compared with 50% distant metastasis rate in group 1 (p53-mutant; n=36) and 39% in group 4 (NSMP; P<0.001). Five-year recurrence-free survival was 93% and 95% for group 3 (POLE-mutant) and group 2 (microsatellite instable) vs 42% (group 1, p53-mutant) and 52% (group 4, NSMP; P<0.001). Targetable FBXW7 and FGFR2 mutations (6%), alterations in the PI3K-AKT pathway (60%) and hormone receptor positivity (45%) were frequently found. In conclusion, molecular analysis of high-risk endometrial cancer identifies four distinct prognostic subgroups, with potential therapeutic implications. High frequencies of targetable alterations were identified and may serve as targets for individualized treatment.

PMID:
25720322
DOI:
10.1038/modpathol.2015.43
[Indexed for MEDLINE]
Free full text
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Nature Publishing Group
    Loading ...
    Support Center