Abstract：
OBJECTIVE: Endometrial cancer (EC) treatment changed substantially with the introduction of molecular classification. Low-middle income (LMIC) countries will face barriers to including molecular classification to guide treatment. This study aims to analyse the value of p53 immunohistochemistry to delineate adjuvant treatment in FIGO stages I and II.
METHODS: Patients with EC treated between 2010 and 2016 were retrospectively evaluated. Patients included in this analysis must have reviewed FIGO stage I/II high-grade histologies (endometrioid grade 3, serous, clear cell, carcinosarcoma, mixed and undifferentiated). Samples were subjected to p53 immunohistochemistry. Recurrence-free and overall survival were analysed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was performed for multivariable analysis.
RESULTS: From 2010 to 2016, 265 patients met the inclusion criteria. Patients with aberrant p53 (71.4 %) were associated with older age (59.7 % vs 77.8 % with more than 60 years), relapse (12.5 vs 29.6 %) and death (22.2 vs 46.7 %). The pattern of relapse was not different, with most being at extrapelvic sites (55.5 % vs 62.3 % for p53 wild type and aberrant, respectively). The median overall survival was not reached versus 92.2 months for p53 wild type and aberrant, respectively (p = 0.003). In multivariate analysis, chemotherapy decreased death (p = 0.014) in p53 aberrant tumours, a benefit not seen in the wild-type cohort (p = 0.22).
CONCLUSIONS: This retrospective analysis corroborates the finding of worse outcomes for p53 aberrant tumours in stage I/II EC and the benefit of more aggressive adjuvant treatment (systemic therapy and radiotherapy). Although not ideal as a sole molecular marker, p53 immunohistochemistry could complement the classical anatomopathological features and be part of the decision-making process with patients in LMIC.
METHODS: Patients with EC treated between 2010 and 2016 were retrospectively evaluated. Patients included in this analysis must have reviewed FIGO stage I/II high-grade histologies (endometrioid grade 3, serous, clear cell, carcinosarcoma, mixed and undifferentiated). Samples were subjected to p53 immunohistochemistry. Recurrence-free and overall survival were analysed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was performed for multivariable analysis.
RESULTS: From 2010 to 2016, 265 patients met the inclusion criteria. Patients with aberrant p53 (71.4 %) were associated with older age (59.7 % vs 77.8 % with more than 60 years), relapse (12.5 vs 29.6 %) and death (22.2 vs 46.7 %). The pattern of relapse was not different, with most being at extrapelvic sites (55.5 % vs 62.3 % for p53 wild type and aberrant, respectively). The median overall survival was not reached versus 92.2 months for p53 wild type and aberrant, respectively (p = 0.003). In multivariate analysis, chemotherapy decreased death (p = 0.014) in p53 aberrant tumours, a benefit not seen in the wild-type cohort (p = 0.22).
CONCLUSIONS: This retrospective analysis corroborates the finding of worse outcomes for p53 aberrant tumours in stage I/II EC and the benefit of more aggressive adjuvant treatment (systemic therapy and radiotherapy). Although not ideal as a sole molecular marker, p53 immunohistochemistry could complement the classical anatomopathological features and be part of the decision-making process with patients in LMIC.
摘要：
目的：随着分子分类的引入，子宫内膜癌（EC）治疗发生了实质性变化。中低收入（LMIC）国家在纳入分子分类指导治疗方面将面临障碍。这项研究旨在分析p53免疫组织化学的价值，以描述FIGOI和II期的辅助治疗。
方法：对2010年至2016年接受治疗的EC患者进行回顾性评估。本分析中包括的患者必须检查FIGOI/II期高级别组织学（子宫内膜样3级，浆液，透明细胞,癌肉瘤,混合和未分化)。对样品进行p53免疫组织化学。使用Kaplan-Meier方法和对数秩检验分析无复发和总生存期。Cox比例风险回归进行多变量分析。
结果：从2010年到2016年，265例患者符合纳入标准。p53异常患者（71.4％）与年龄较大（59.7％vs60岁以上的77.8％）有关，复发（12.5vs29.6%）和死亡（22.2vs46.7%）。复发的模式没有什么不同，大部分位于肾盂外部位(p53野生型和异常型为55.5%vs62.3%，分别)。与p53野生型和异常的92.2个月相比，中位总生存期未达到，分别(p=0.003)。在多变量分析中，化疗减少了p53异常肿瘤的死亡（p=0.014），在野生型队列中没有看到的益处(p=0.22)。
结论：这项回顾性分析证实了在I/II期EC中p53异常肿瘤的预后较差，以及更积极的辅助治疗（全身治疗和放疗）的益处。虽然作为唯一的分子标记并不理想，p53免疫组织化学可以补充经典的解剖病理学特征，并成为LMIC患者决策过程的一部分。
方法：对2010年至2016年接受治疗的EC患者进行回顾性评估。本分析中包括的患者必须检查FIGOI/II期高级别组织学（子宫内膜样3级，浆液，透明细胞,癌肉瘤,混合和未分化)。对样品进行p53免疫组织化学。使用Kaplan-Meier方法和对数秩检验分析无复发和总生存期。Cox比例风险回归进行多变量分析。
结果：从2010年到2016年，265例患者符合纳入标准。p53异常患者（71.4％）与年龄较大（59.7％vs60岁以上的77.8％）有关，复发（12.5vs29.6%）和死亡（22.2vs46.7%）。复发的模式没有什么不同，大部分位于肾盂外部位(p53野生型和异常型为55.5%vs62.3%，分别)。与p53野生型和异常的92.2个月相比，中位总生存期未达到，分别(p=0.003)。在多变量分析中，化疗减少了p53异常肿瘤的死亡（p=0.014），在野生型队列中没有看到的益处(p=0.22)。
结论：这项回顾性分析证实了在I/II期EC中p53异常肿瘤的预后较差，以及更积极的辅助治疗（全身治疗和放疗）的益处。虽然作为唯一的分子标记并不理想，p53免疫组织化学可以补充经典的解剖病理学特征，并成为LMIC患者决策过程的一部分。
