The clinicopathology and survival characteristics of patients with POLE proofreading mutations in endometrial carcinoma: A systematic review and meta-analysis.

Alaa Salah Jumaah,Akeel Abed Yasseen,Katherine Ann Mcallister,Hawraa Sahib Al-Haddad,Manish S Patankar

doi:10.1371/journal.pone.0263585

Alaa Salah Jumaah, Akeel Abed Yasseen + Show 3 more

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https://doi.org/10.1371/journal.pone.0263585

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Abstract

Endometrial carcinoma (EC) is classified into four distinct molecular subgroups. Patients with polymerase epsilon exonuclease domain mutated (POLE-EDM) tumors have the best prognosis of all. This meta-analysis consolidated the clinicopathology variations reported in the POLE-mutant subtype and survival parameters in patients with EC. The following internet data bases were searched: PubMed, Web of science, Embase and Scimage directory. Data was extracted from eligible studies including sample size, number of positive POLE-mutant cases, EDM sequencing information, clinicopathologic, and survival data. Meta-analysis and a random-effects model produced pooled estimates of POLE prognostic parameters using 95% confidence intervals (CI), hazard ratios (HR), and odds ratios (OR). The meta-analysis included 11 cohort studies comprising 5508 EC patients (442 POLE EDM tumors). Patients with POLE mutant EC were associated with improved disease specific survival (HR = 0.408, 95% CI: 0.306 to 0.543) and progression-free survival (HR = 0.231, 95% CI: 0.117 to 0.456). POLE-mutated tumors were mostly endometrioid histology (84.480%; 95% CI: 77.237 to 90.548), although not significantly more than wild type tumors (OR = 1.386; p = 0.073). The POLE mutant tumors significantly present (p<0.001) at Federation of International of Gynecologists and Obstetricians (FIGO) lower stages I-II (OR = 2.955, p<0.001) and highest grade III (OR = 1.717, P = 0.003). The tumors are significantly associated with invasion less than half (<50%) of the myometrium (OR = 1.765, p = 0.001), but not deeply invasive EC (MI>50%, OR = 0.83, p = 0.34). POLE mutations significantly protected against lymph node metastases (OR = 0.202, p = 0.001), and have no clear association with lymph-vascular space invasion (OR = 0.967, 95% 0.713-1.310, p = 0.826). The tumors are predominantly of low ESMO risk stratification distribution (40.356%; 95% CI: 27.577 to 53.838). POLE mutations serve as an important biomarker of favorable prognosis in EC. The tumors are characteristically high grade, early stage, and remain localized in the endometrium with reduced likelihood of lymph node metastasis for improved survival prospects and the lowest risk classification. These findings have implications for medical management of EC.

Highlights

Endometrial cancer (EC) is the most common gynecologic cancer in the USA, Japan and developing countries [1, 2]
Patients with POLE mutant Endometrial carcinoma (EC) were associated with improved disease specific survival (HR = 0.408, 95% confidence intervals (CI): 0.306 to 0.543) and progression-free survival (HR = 0.231, 95% confidence interval (95% CI): 0.117 to 0.456)
POLE-mutated tumors were mostly endometrioid histology (84.480%; 95% CI: 77.237 to 90.548), not significantly more than wild type tumors (OR = 1.386; p = 0.073)

Summary

Introduction

Endometrial cancer (EC) is the most common gynecologic cancer in the USA, Japan and developing countries [1, 2]. Patients with advanced and recurrent disease have poor prognosis, even with surgery and adjuvant therapy [4]. Clinicopathology risk assessments are based on tumor stage, grade, and histology subtype [3]. There are reproducibility issues associated with traditional histopathology analysis of endometrial tumors among women [6, 7]. Use of molecular classification of EC offers an opportunity to improve risk assessments and treatment of women, especially over usage and underusage of adjuvant therapy [8]. Patients with polymerase epsilon exonuclease domain mutated (POLE-EDM) tumors have the best prognosis of all.

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