Integration of Molecular and Histopathologic Classification: A Pathway to Optimize Treatment and Prognosis in Endometrial Cancer
DOI:
https://doi.org/10.32635/2176-9745.RBC.2026v72n2.5689Keywords:
Endometrial Neoplasms, Postmenopause, Cytogenetic Analysis/methods, Precision Medicine/methodsAbstract
Introduction: Endometrial cancer, the sixth most common neoplasm in postmenopausal women, is experiencing a rising global incidence. Traditionally, it is classified into type I (endometrioid) and type II (non-endometrioid), and more recently into four molecular groups with different prognostic and therapeutic implications. Objective: To analyze the impact of integrating histopathology and molecular biology on the understanding of EC and its influence on treatment and patient prognosis. Method: A retrospective study of 1,451 EC cases from The Cancer Genome Atlas (TCGA) project, using ANOVA, t-tests, and chi-square tests for genomic and clinical evaluation. Results: Endometrioid carcinoma was predominant, with a mean age at diagnosis of 63.7 years and variations in overall survival by race. Adjuvant radiotherapy was effective in patients with endometrioid carcinoma, with an overall survival of 35.4 months. Neoadjuvant therapy significantly improved overall survival in uterine papillary serous carcinomas. 87% of patients with endometrioid carcinoma, 48% with mixed endometrial carcinoma, and 25% with undifferentiated endometrial carcinoma benefited from detailed molecular analysis. The molecular groups showed distinct gene expression characteristics. Group 1 suggested dynamic disease control. Group 2 was dominated by genes related to the cell cycle and chromatin stability. Group 3 highlighted genes involved in chromatin remodeling and cell proliferation, while Group 4 was characterized by TP53 expression and genes related to the PI3K-AKT pathway. Conclusion: Given the molecular complexity of endometrial cancer, integrating histopathological and molecular analyses is essential for guiding precise treatments, increasing therapeutic efficacy, and improving clinical outcomes.
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