Onkológia 4/2021

Update of endometrial carcinoma risk groups. Retrospective analysis of 164 cases of hysterectomy in the light of new recommendations

Purpose: In 2021, ESGO/ESTRO/ESP (European Society of Gynaecological Oncology/European SocieTy for Radiotherapy and Oncology/ European Society of Pathology) comes up with new guidelines for the management of patients with endometrial carcinoma (EC), based on the need to update new accumulated knowledge since 2014. Patients and methods: The article retrospectively revised 164 cases of hysterectomy with a diagnosis of EC in the interval of 2019 and 2020, examined in the Laboratory of Medicyt, s.r.o. in Trencin. All cases stratified to risk groups according to the latest clinical recommendations of ESMO (European Society for Medical Oncology) at the time of writing were confronted with new guidelines. Results: When applying the changes of the new criteria, without knowledge of the molecular classification, in 14 (8.5%) cases the EC was regrouped into a more prognostically favorable risk group. In 7 cases with an impact on the omission of adjuvant treatment. In the area of high-intermediate risk and high risk goups 23 (14%) tumors were recorded with a loss of MMR proteins expression, where no significant benefit from adjuvant chemotherapy can be expected. In the spectrum of adjuvant treatment, there were 9 (5.5%) EC cases in which molecular classification would be crucial. Conclusion: The new guidelines are more gentle in the treatment burden when changing the criteria of risk groups. The introduction of molecular classification with the diagnosis of pathogenic POLE mutations should further accentuate this effect and, conversely, make it possible to identify high-risk p53 abnormal EC.

Keywords: endometrial carcinoma, guidelines, risk group, molecular classification, adjuvant treatment