Molecular aberrations in late-stage dedifferentiated/undifferentiated endometrial carcinoma: A review of current literature.

Abstract

e17632 Background: Uterine cancer remains the fourth most common cancer diagnosed and seventh most common cause of cancer death in American women. Four molecular subtypes have been created to categorize and prognosticate endometrial carcinoma based on their molecular aberrations, but are often based on initial tumor presentation and are associated with high cost to the healthcare system. Methods: A comprehensive literature search was performed on PubMed, ClinicalTrials.gov, Embase, and WebofScience. Abstracts and publications from ASCO/ASH were also included. Results: 32 articles were included in our systematic review. A total of 388 women were analyzed in the main group analysis and nearly half of the patients were diagnosed as stage III or IV (n = 178, 46%). MSI was present in 66% of all tumors tested and PD-L1 was overexpressed in 78%. Eighty-four percent (84%) of the tumors were negative for ER, up to 44% had loss in SWI/SNF complex, and 64% lost expression of e-cadherin. Pax-8 and fascin proteins were over expressed in 29% and 88% of patients tested, respectively. In a sub-group analysis, evidence of progression and use of adjuvant radiotherapy were significantly associated with a later stage of diagnosis ( p = 0.052, 0.044). Conclusions: We found no statistically significant association between stage of diagnosis and unique mutation. Patients with evidence of progression or recurrence were found to have disease in atypical locations. Unique mutations which categorize patients at time of diagnosis may be different upon progression or recurrence of the tumor. While a novel classification system has been produced to assist with prognosis and treatment guidelines, these tests are not widely available in the community hospital setting.[Table: see text]