子宫内膜癌分子分型在术后辅助治疗选择中的应用价值

The influence of molecular classification in the selection of postoperative adjuvant therapy in endometrial carcinoma

目的探讨子宫内膜癌(EC)分子分型在术后辅助治疗选择中的应用价值。方法回顾性分析2022年1月至2022年4月196例在北京大学第三医院接受手术治疗并且病理分期为Ⅰ期的EC患者的临床资料,分析不同分子分型EC患者术后选择辅助治疗方案的差异。结果196例患者的年龄为(55.1±10.2)岁,体质指数(BMI)为(26.0±3.9)kg/m2;POLE突变型19例(9.7%),错配修复系统缺陷型(dMMR)28例(14.3%),无特异性分子谱型(NSMP)142例(72.4%),p53突变型(p53abn)7例(3.6%)。不同分子分型EC患者术后选择辅助治疗方案情况差异有统计学意义(P=0.003)。POLE突变型、dMMR型和NSMP型EC患者术后选择放疗,或者放化疗联合方案情况差异均无统计学意义(均P>0.0125),p53abn型EC患者术后选择辅助放疗方案情况差异无统计学意义(P=0.209),但术后选择放化疗联合治疗方案情况差异有统计学意义(P<0.001),p53abn型患者选择放化疗联合方案的比例高于非此型别患者[5/7比14.4%(27/188)]。结论EC分子分型中的p53abn型患者术后选择放化疗联合治疗方案可能性更大。

Objective To study the value of molecular classification in postoperative adjuvant therapy for endometrial carcinoma(EC).Methods Patients with stageⅠEC who underwent surgical‑pathological staging surgery and molecular classification in Peking University Third Hospital from January 2020 to April 2022 were retrospectively analyzed.The influence of different molecular types of EC on postoperative adjuvant therapy were studied.Results The age of the 196 patients was(55.1±10.2)years old,and the body mess index(BMI)was(26.0±3.9)kg/m2.Molecular classification was performed in 196 stageⅠEC patients,identifying the 4 subgroups:POLE mutation(POLEmut,n=19,9.7%),mismatch repair‑deficient(dMMR,n=28,14.3%),no‑specific molecular profile(NSMP,n=142,72.4%)and p53 mutation(p53abn,n=7,3.6%).Molecular classification was one of the influencing factors on the selection of postoperative adjuvant therapy for EC patients(P=0.003).POLEmut,dMMR and NSMP subtypes were not the variables in selecting radiotherapy or combined chemo‑radiotherapy postoperatively.p53abn subtype was not the influencer for radiotherapy,however,it may contribute to the selection of combined chemo‑radiotherapy postoperatively(P<0.001).Conclusion The p53abn subtype in the molecular classification is an influencing factor in the selection of combined chemo‑radiotherapy for EC patients postoperatively.