Endometrial cancer ProMisE classification predicts the risk of lymph node metastasis and prognosis

Objective: To assess the correlation between ProMisE classification and lymph node metastasis(LNM) of endometrial carcinoma(EC). Design: A retrospective cohort study. Setting: Department of gynecologic oncology at Liaoning Cancer Hospital in China. Population:From January 1st,2014 to December 31st, 2018,a total of 74 women with EC were included.32 cases had pelvic or para-aortic LNM and 42 cases had no LNM. Methods: The formalin-fixed paraffin-embedded(FFPE) tissue sections of EC patients were analyzed by the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification,and to evaluate the correlation between ProMisE classification and LNM and prognosis of the patients receiving different postoperative adjuvant therapies. Main outcome measure:Correlation between ProMisE classification and LNM,Overall Survival(OS) and progression-free survival(PFS). Results: In the ProMisE classification,mismatch repair deficient(MMRd) was linked to low pathological grade (p value=0.006; correlation=-0.315), p53 abnormal subtype(p53abn) was correlated with LNM (p value=0.0004; correlation=-0.472) and late International Federation of Gynecology and Obstetrics (FIGO) stage (p value=0.005; correlation=-0.386).The 5-year overall survival was 100% in Polymerase Epsilon exonuclease domain mutated(POLE EDM), 85% in MMRd, 91.2% in p53 wild-type(p53wt) and 83.3% in p53abn.The 5-year PFS was 100% in POLE EDM, 95% in MMRd, 94.1% in p53wt and 77.8% in p53abn.We also found no statistical difference in patients‘ benefits from Radiotherapy(RT) alone and concurrent chemoradiotherapy(CCRT) in different molecular subtypes,however,the patients had a trend toward benefit from CCRT in the p53abn subtype. Conclusions: ProMisE classification can predict the risk of LNM,histological grade,clinical staging and prognosis, which is expected to guide the postoperative adjuvant treatment of EC patients.