Molecular Classification and Prognostic Factors in Endometrial Cancer: A Multicenter Retrospective Cohort Study

Abstract

Data integrating molecular classification, clinicopathological factors, and survival in Asian endometrial cancer (EC) are limited. We retrospectively analyzed 121 patients with EC from three Taiwanese hospitals (2010–2020); molecular subtypes were assigned in 89 using POLE hotspot PCR and immunohistochemistry for mismatch repair proteins and p53. Overall survival (OS) was analyzed using Kaplan–Meier and Firth-penalized Cox regression. Subtypes were no specific molecular profile (NSMP; 64.0%), p53-abnormal (p53abn; 15.7%), POLE-mutated (POLEmut; 14.6%), and mismatch repair-deficient (MMRd; 5.6%). OS differed by subtype (p = 0.013), being poorest for p53abn (31.7%) and favorable for POLEmut (90.9%) and MMRd (no deaths). FIGO stage III–IV independently predicted mortality (adjusted hazard ratio [aHR] 17.13, 95% CI: 5.07–60.49), whereas p53abn was not significant after stage adjustment (aHR 2.34, 95% CI: 0.67–8.09). PCR- and immunohistochemistry-based molecular classification is feasible in a multicenter Taiwanese setting; FIGO stage remained the dominant prognostic factor in this small cohort.