ArticleClinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico2026
Associations between molecular subtypes and high-risk pathological factors in endometrial cancer.
Article in Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndometrial carcinoma (EC) molecular subtypes are critical for risk assessment and treatment guidance, with strong prognostic implications.
objectivesTo investigate associations between EC molecular subtypes and high-risk pathological factors to optimize individualized therapy.
designMulticenter retrospective cohort study.
methodsRetrospective analysis of 292 EC cases classified via the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) into four subtypes: POLE ultramutant (POLE-mut), mismatch repair deficient (MMRd), p53 abnormal (p53 abn), and p53 wild-type (p53 wt). Associations with clinicopathological parameters were assessed using chi-square tests and logistic regression.
resultsAmong the 292 patients, the distribution of molecular subtypes was as follows: POLE-mut (6.8%), MMRd (21.2%), p53 abn (14.4%), and p53 wt (57.5%). Molecular subtypes correlated significantly with International Federation of Gynecology and Obstetrics (FIGO) stage (p < 0.001), poor/undifferentiated histology (p < 0.001), and lymphovascular space invasion (LVSI) (p = 0.001). The POLE-mut and p53 wt were predominantly enriched in stage I disease (90.0% and 80.4%, respectively). In contrast, the majority of p53 abn were classified as stage II (81.0%). The MMRd subtype was distributed across all stages. Advanced stages (III-IV) were most frequently observed in the p53 abn and MMRd subtypes. p53 abn showed the highest rate of poor/undifferentiated histology (61.9%). MMRd comprised the largest proportion of LVSI-positive cases (39.1%). Multivariate analysis identified MMRd as an independent predictor of LVSI (p = 0.001), while both MMRd (p = 0.009) and p53 abn (p < 0.001) independently predicted poor/undifferentiated histology.
conclusionsEC molecular subtypes stratify clinicopathological risk and predict tumor behavior, highlighting their potential utility in informing individualized management. These findings suggest possible roles ranging from treatment de-escalation (POLE‑mut) to treatment intensification (p53‑abn), although further prospective studies are needed before routine clinical implementation.
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