Evaluation of the TCGA-Surrogate (ProMisE) Molecular Classification and Clinical Features of Endometrial Carcinoma: A Study of 97 Cases from China

Li-Yu Chen,1 Jian-Hui Fu,2 Liu Liao,2 Dan Luo,2 Shu-Xia Xu,2 Hui-Bin Zhang,2 Jian-Song Lin2 1Department of Pathology, Affiliated Hospital of Putian University, Putian, Fujian, 351100, People’s Republic of China; 2Department of Pathology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, Fujian, 351100, People’s Republic of ChinaCorrespondence: Jian-Song Lin, Department of Pathology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18, Daoshan Street, Gulou District, Fuzhou, 350001, People’s Republic of China, Tel +86-13559110096, Email linjiansong3292@163.com Hui-Bin Zhang, Department of Pathology, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, No. 18, Daoshan Street, Gulou District, Fuzhou, 350001, People’s Republic of China, Tel +86-13559110096, Email zhanghuibin2016@21cn.comBackground: Molecular classification of endometrial carcinoma (EC) has gained prominence. This study is a retrospective analysis exploring the value of molecular classification in clinical practice in a Chinese cohort.Methods: Ninety-seven patients with EC were enrolled in this study. Patient-derived EC samples were used for polymerase-ɛ exonuclease domain mutation (POLE edm) sequencing. The presence and defects of mismatch repair (MMR) proteins were identified using immunohistochemistry (IHC). Similarly, tumour protein 53 (p53) was identified using IHC. Recurrence-free survival (RFS) was tested between groups using Kaplan–Meier curves with the Log rank test.Results: Distribution by molecular subtype was as follows: POLE edm (3 patients; 3.1%); MMR deficient (MMRd) (32 patients; 33%); abnormal p53 (p53abn) (49 patients; 50.5%) and wild-type p53 (p53wt) (13 patients; 13.4%). Actual RFS rates for the different molecular subtypes were as follows: POLE edm (100%); MMRd (93.5%); p53abn (77.8%) and p53wt (84.6%). Differences in morphology, myometrial invasion, cervical stromal invasion and lymphovascular space invasion among groups were not significant (p > 0.05), but the same was not the case for cervical epithelial invasion. Cervical mucosa invasion in the POLE edm group was significantly different from the other three groups (p < 0.05). The results of Kaplan–Meier RFS curves showed that the p-value was 0.300 (Log rank test) in molecular subtypes and 0.386 (Log rank test) in the group with/without cervical involvement.Conclusion: Our results suggest that cervical stromal invasion in EC may have no prognostic significance, the EC ProMisE classifier has no relationship with morphology and routine use of molecular classification is premature. The study was limited by a relatively small sample size and short follow-up duration, and further multicenter studies are warranted to validate these findings.