Journal: Obstetrics and gynecology
This publication reviews the evolving classification of endometrial cancer (EC), moving from traditional histologic methods to molecular characterization, which is essential for prognosis and treatment guidance.
It highlights four key molecular subtypes recommended by the World Health Organization since 2020:
- POLE-mutated
- Mismatch repair deficient (MMR)
- p53 abnormal
- No specific molecular profile (NSMP), further stratified by estrogen receptor (ER) status
POLE-mutated tumors have the best prognosis, followed by ER-positive NSMP. MMR-deficient tumors show intermediate outcomes, while p53 abnormal and ER-negative NSMP tumors have the poorest prognosis.
Additional biomarkers such as tumor mutational burden, HER2, L1CAM, β-catenin, and lymphovascular invasion are emerging with prognostic and predictive roles.
Current guidelines recommend routine testing for MMR, p53, and ER, with POLE testing in select cases.
Molecular classification is critical for personalized care, consistent diagnosis, prognosis, and optimizing clinical trial design.