Pinyada Panyavaranant

Clinicopathological characteristics and survival outcomes of women aged ≤45 and >45 years with endometrial adenocarcinoma in tertiary referral hospital: a 21-year cohort study

Objective This study aimed to compare clinicopathological characteristics and oncological outcomes in patients with endometrial cancer aged ≤45 and >45 years, with a focus on identifying distinct traits and prognostic factors in younger patients. Design A retrospective cohort study. Setting The study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, with a restricted study population from 1996 to 2016. Participants A total of 1114 patients diagnosed with endometrial cancer and underwent surgery were strictly selected, excluding those who had received primary radiotherapy or had uterine sarcoma. Among the population, 188 patients (16.9%) were ≤45 years old and 926 patients (83.1%) were >45 years old. Outcome measures The primary outcome measures were disease-free survival (DFS) and overall survival (OS) at 5, 10 and 15 years, with an analysis of survival rates based on patient age groups and prognostic factors. Results Younger patients (≤45 years) displayed significantly higher rates of obesity, nulliparity and polycystic ovary syndrome (PCOS), as well as favourable pathological characteristics such as well-differentiated tumours and lower rates of myometrial invasion. They also exhibited better long-term survival outcomes, the DFS rates at 5, 10 and 15 years were 89.6% (95% CI: 84.0 to 98.3), 85.9% (95% CI: 79.0 to 90.6) and 76.8% (95% CI: 63.3 to 85.9), respectively, compared with 77.6% (95% CI: 74.6 to 80.2), 69.2% (95% CI: 65.6 to 72.5) and 53.5% (95% CI: 48.0 to 58.6) in the older group. Similarly, the OS rates at 5, 10 and 15 years were 94.7% (95% CI: 90.1 to 97.2), 91.7% (95% CI: 85.4 to 95.3) and 74.0% (95% CI: 51.7 to 87.2), respectively, compared with 86.9% (95% CI: 84.4 to 89.0), 76.6% (95% CI: 73.0 to 79.7) and 60.7% (95% CI: 55.0 to 65.8) in the older group. Independent prognostic factors consist of non-endometrioid histology, involvement of the lower uterine segment and cervix, omental metastasis, lymphovascular invasion and advanced stage. Conclusions Young patients with endometrial cancer exhibit distinct favourable clinicopathological characteristics associated with better oncological outcomes compared with older patients. However, certain aggressive disease features should be taken into consideration as they have a negative influence on prognosis significantly. These insights emphasise the need for targeted management strategies and further research.

Simplifying Mismatch Repair Deficiency Screening in Endometrial Adenocarcinoma: Immunohistochemistry with Two-Antibody Panel (PMS2 and MSH6)

Mismatch repair deficiency (dMMR) is a well-established characteristic of endometrial adenocarcinoma and is crucial in screening for Lynch syndrome, guiding adjuvant treatment decisions, and identifying candidates for immune checkpoint inhibitors. The traditional approach to dMMR screening involves a four-antibody panel, but a simplified two-antibody method utilizing PMS2 and MSH6 has shown promise. This study aims to compare the diagnostic performance of the simplified two-antibody method with the traditional four-antibody panel in endometrial cancer samples. We conducted a retrospective cohort study on endometrial carcinoma cases diagnosed between 2013 and 2022. We compared the diagnostic performance of the two-antibody panel with the traditional four-antibody panel in detecting dMMR. Clinical data and immunohistochemistry results were collected, and agreement between the two methods was evaluated using Cohen's kappa coefficient. 304 endometrial cancer cases were included, with 27% demonstrating loss of at least one MMR protein using the four-antibody panel. The two-antibody method detected MMR deficiency in 26.6% of cases, with a high agreement rate of 98.8% between the two methods. Only one case showed discordant results, prompting further investigation. The simplified two-antibody MMR IHC screening approach using PMS2 and MSH6 showed high concordance with the traditional four-antibody panel. This suggests its potential as an alternative method for reflex MMR status testing in endometrial adenocarcinoma. The implementation of this approach could streamline the diagnostic process, reduce costs, and improve the detection of Lynch syndrome in affected individuals and their families. Further studies with larger cohorts and long-term follow-up are needed to validate these findings and assess the clinical implications of this approach in routine practice.