A1 Refereed original research article in a scientific journal
Surgical stage in the era of molecular profiling of endometrial cancer
Authors: Kasius J.C.; Kildal W.; Vrede S.W.; Askautrud H.A.; Pradhan M.; van Altena A.M.; Tobin K.-A.R.; Knoll K.; Reijnen C.; Reimann S.; Dackus G.; Vlatkovic L.; Huvila J.; Steinlechner M.; Tubita V.; Gil-Moreno A.; Snijders M.P.L.M.; Vos M.C.; Hveem T.S.; Asberger J.; Zeimet A.G.; Matias-Guiu X.; Lindemann K.; Weinberger V.; Visser N.C.M.; Kristensen G.B.; Amant F.; Pijnenborg J.M.A.; Kleppe A.
Publisher: Pergamon Press
Publication year: 2026
Journal: European Journal of Cancer
Article number: 116164
Volume: 233
ISSN: 0959-8049
eISSN: 1879-0852
DOI: https://doi.org/10.1016/j.ejca.2025.116164
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Partially Open Access publication channel
Web address : https://doi.org/10.1016/j.ejca.2025.116164
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/506143257
Introduction Molecular classification has reshaped risk stratification in endometrial cancer (EC), yet the relevance of tumor spread within molecular subgroups has not been reported so far. Material and methods This multicenter retrospective study included 2056 EC patients treated between 1994 and 2018 across 11 European centers. All histopathological subtypes and FIGO stages were included. Tumors were classified into four molecular subgroups: POLE -mutated ( POLE mut), mismatch repair deficient (MMRd), no specific molecular profile (NSMP), and TP53/ p53 abnormal (p53abn). Clinical and pathological data were extracted from existing cohort databases. Results Patients were diagnosed with FIGO stage I (69 %), II (9 %), III (16 %), and IV (6 %), and classified into: POLE mut (8 %), MMRd (28 %), NSMP (44 %), and p53abn (21 %). The overall 5-year cancer-specific death (CSD) and recurrence rates were 16.5 % (95 % CI, 14.9 %-18.2 %) and 23.8 % (95 % CI, 22.0 %-25.7 %), respectively. In multivariable analysis cancer-specific survival (CSS) was independently associated with molecular subtype, FIGO stage, age, histopathological type, grade, lymphovascular space invasion, adjuvant therapy, residual tumor, and lymphadenectomy. FIGO stage was significantly associated with CSD also in within each molecular subgroup (p < 0.001). Patients with tumors confined to the uterus had the most favourable prognosis. Lymph node metastases significantly decreased CSS in POLE mut, MMRd, and p53abn groups. Within FIGO stage IV, molecular subtype was not significantly related to outcome. Discussion Surgical stage remains a strong prognostic factor across molecular subtypes and should be considered alongside molecular classification when tailoring adjuvant treatment in EC. © 2025 The Authors.
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Funding information in the publication:
This work was supported by the Norwegian Cancer Society [grant number 198168], and the Dutch Cancer Society [grant number 14032]. The funders had no role in study design, data collection, data analysis, data interpretation, wr