基于基因组图谱的模型 (GP-M) 是子宫内膜癌 (EC) 分子分类的黄金标准，但与低收入环境中基因组测序的可用性相关的几个问题仍然存在，并且管理中的健康差距正在扩大。本研究旨在探讨仅免疫组织化学模型在肿瘤学结果方面与基于标准基因组分析的模型相比在对 EC 进行分类时的非劣效性。回顾性纳入了所有术前接受手术分期的子宫局限 EC。根据 IHC-M 分类的患者分为：MMR 熟练 (MMRp)、p53 野生型 (p53wt) 和雌激素受体 (ER) 阳性、2) MMRp、p53wt 和 ER 阴性、3) MMRd 和 4) p53abn。在 IHC-M 和 GP-M 队列之间进行了病例对照比较。然后进行倾向匹配分析：将IHC-M分类的EC与GP-M分类的患者以3:1的比例进行匹配。纳入了1587名EC患者。无病生存率和总生存率的 Kaplan-Meier 生存曲线表明，这两种模型在对研究人群进行风险分层方面表现相似 (p < 0.0001)。此外，AUC-ROC 显示出重叠的结果：IHC-M 为 0.77（0.66-0.87），GP-M 为 0.72（0.63-0.81），表明两种模型都能够成功识别高风险和低风险患者与 GP-M 相比，IHC-M 在肿瘤学结果方面表现出重叠的分类性能。这项研究可能为进一步研究 POLE 测序在分子分类中的现实临床影响以及 ER 状态对 EC 患者进一步分配风险类别的潜在独立预后作用奠定基础。版权所有 © 2024。由 Elsevier Inc 出版。

Genomic profiling-based model (GP-M) is the gold-standard for endometrial cancer (EC) molecular classification, but several issues related to the availability of genomic sequencing in low-income settings remain and health disparities in the management are increasing. This study aims to investigate the non-inferiority of the immunohistochemistry-alone model in classifying ECs compared to the standard genomic profiling-based model in terms of oncologic outcomes.All preoperative uterine-confined ECs undergoing surgical staging were retrospectively included. Patients classified by IHC-M were stratified into: MMR-proficient (MMRp), p53 wild type (p53wt) and estrogen receptor (ER) positive, 2) MMRp, p53wt and ER-negative, 3) MMRd, and 4) p53abn. A case-control comparison was performed between the IHC-M and GP-M cohorts. Then, a propensity-matched analysis was performed: ECs classified by IHC-M were matched in a 3:1 ratio with patients classified by GP-M.1587 patients with EC were included. The Kaplan-Meier survival curves for disease-free survival and overall survival demonstrated that the two models performed similarly in risk-stratifying the study population (p < 0.0001). Moreover, the AUC-ROC showed overlapping results: 0.77 (0.66-0.87) for IHC-M and 0.72 (0.63-0.81) for GP-M, indicating that both models were able to successfully identify patients at high-risk and low-risk of disease recurrence/progression.The IHC-M showed overlapping classification performance compared to the GP-M in terms of oncologic outcomes. This study may lay the basis to further investigate the real-life clinical impact of POLE sequencing in molecular classification and the potential stand-alone prognostic role of ER status for further allocation of EC patients into risk classes.Copyright © 2024. Published by Elsevier Inc.