Background: Endometrial carcinoma is the most common gynaecological cancer in developed countries and its incidence is increasing. The European Society of Gynaecological Oncology (ESGO), the European Society of Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) jointly drafted and published new guidelines for the management of patients with endometrial cancer in January 2021. The primary therapeutic approach to endometrial cancer is laparoscopic surgery involving total hysterectomy and bilateral salpingo-oophorectomy, while the performance of lymph node excision as standard surgery in all patients is under discussion. The new ESGO-ESTRO-ESP guidelines recommend immunohistochemical (IHC) and molecular study and classification into prognostic risk groups in all patients with endometrial cancer in order to correctly design adjuvant therapy. Aim: The aim of the study is to evaluate whether in women with endometrial cancer, the performance of IHC and molecular analysis in diagnostic biopsy can contribute to the personalisation of surgical treatment. Materials and methods: The study conducted is a prospective observational study. Patients with histological diagnosis of endometrial carcinoma by performing an endometrial biopsy through hysteroscopic and with IHC and molecular characterization at least on the surgical specimen were included. For all patients, clinical data (BMI and age at surgery), IHC and molecular analysis data on the diagnostic biopsy (when available) and on the biopsy of the operative piece, radiological and operative data were collected. Based on the available information, each patient was assigned to a pre-surgical and post-surgical prognostic risk group. Finally, with reference to the ESGO-ESTRO-ESP 2021 prognostic risk classes, customised surgery was proposed. Results: The study included 49 patients. Thirteen (26.5%) patients could benefit from a modified surgical approach based on IHC and molecular analysis of the diagnostic biopsy. The concordance recorded between IHC and molecular analysis on the diagnostic biopsy and the final histological diagnosis was 100%. Conclusions: IHC and molecular analysis on the diagnostic biopsy with stratification of patients into prognostic risk groups already at the preoperative stage could allow personalised management of endometrial cancer surgical therapy.
Background: Il cancro dell'endometrio è il tumore ginecologico più comune nei Paesi sviluppati e la sua incidenza è in aumento. La Società Europea di Oncologia Ginecologica (ESGO), la Società Europea di Radioterapia e Oncologia (ESTRO) e la Società Europea di Patologia (ESP) hanno redatto congiuntamente e pubblicato nel gennaio 2021 le nuove linee guida per la gestione delle pazienti affette da carcinoma endometriale. L’approccio terapeutico primario al tumore dell'endometrio è la chirurgia laparoscopica che prevede un’isterectomia totale ed annessiectomia bilaterale, mentre l’esecuzione dell’escissione linfonodale come chirurgia standard in tutte le pazienti è oggetto di discussione. Le nuove linee guida ESGO-ESTRO-ESP raccomandano lo studio immunoistochimico (IHC) e molecolare e la classificazione in gruppi di rischio prognostici in tutte le pazienti affette da tumore endometriale, al fine di impostare correttamente la terapia adiuvante. Scopo dello studio: Lo studio si propone di valutare se in donne affette da carcinoma dell’endometrio, l’esecuzione dell’analisi IHC e molecolare nella biopsia diagnostica possa contribuire alla personalizzazione del trattamento chirurgico. Materiali e metodi: Lo studio condotto è uno studio osservazionale prospettico. Sono state incluse pazienti con diagnosi istologica di carcinoma dell’endometrio mediante l’esecuzione di una biopsia isteroscopica e con caratterizzazione IHC e molecolare almeno sul pezzo operatorio. Per tutte le pazienti sono stati raccolti i dati clinici (BMI e età all’intervento), i dati relativi all’analisi IHC e molecolare sulla biopsia diagnostica (quando disponibili) e sulla biopsia del pezzo operatorio, i dati radiologici ed operatori. In base alle informazioni a disposizione ogni paziente è stata assegnata ad un gruppo di rischio prognostico pre-chirurgico e post- chirurgico. Infine, con riferimento alle classi di rischio prognostiche ESGO-ESTRO-ESP 2021, è stata proposta una chirurgia personalizzata. Risultati: Lo studio ha incluso 49 pazienti. Tredici (26,5%) pazienti potrebbero beneficiare di un approccio chirurgico modificato basato sull’analisi IHC e molecolare della biopsia diagnostica. La concordanza registrata tra analisi IHC e molecolare sulla biopsia diagnostica e la diagnosi istologica definitiva è stata del 100%. Conclusioni: L’analisi IHC e molecolare sulla biopsia diagnoatica con stratificazione delle pazienti nei gruppi di rischio prognostico già in fase preoperatoria potrebbe consentire una gestione personalizzata della terapia chirurgica del carcinoma dell’endometrio.
Il ruolo della nuova classificazione molecolare nel carcinoma dell'endometrio: la pianificazione pre-chirurgica nell’era della medicina di precisione.
RAICICH, ARIANNA
2021/2022
Abstract
Background: Endometrial carcinoma is the most common gynaecological cancer in developed countries and its incidence is increasing. The European Society of Gynaecological Oncology (ESGO), the European Society of Radiotherapy and Oncology (ESTRO) and the European Society of Pathology (ESP) jointly drafted and published new guidelines for the management of patients with endometrial cancer in January 2021. The primary therapeutic approach to endometrial cancer is laparoscopic surgery involving total hysterectomy and bilateral salpingo-oophorectomy, while the performance of lymph node excision as standard surgery in all patients is under discussion. The new ESGO-ESTRO-ESP guidelines recommend immunohistochemical (IHC) and molecular study and classification into prognostic risk groups in all patients with endometrial cancer in order to correctly design adjuvant therapy. Aim: The aim of the study is to evaluate whether in women with endometrial cancer, the performance of IHC and molecular analysis in diagnostic biopsy can contribute to the personalisation of surgical treatment. Materials and methods: The study conducted is a prospective observational study. Patients with histological diagnosis of endometrial carcinoma by performing an endometrial biopsy through hysteroscopic and with IHC and molecular characterization at least on the surgical specimen were included. For all patients, clinical data (BMI and age at surgery), IHC and molecular analysis data on the diagnostic biopsy (when available) and on the biopsy of the operative piece, radiological and operative data were collected. Based on the available information, each patient was assigned to a pre-surgical and post-surgical prognostic risk group. Finally, with reference to the ESGO-ESTRO-ESP 2021 prognostic risk classes, customised surgery was proposed. Results: The study included 49 patients. Thirteen (26.5%) patients could benefit from a modified surgical approach based on IHC and molecular analysis of the diagnostic biopsy. The concordance recorded between IHC and molecular analysis on the diagnostic biopsy and the final histological diagnosis was 100%. Conclusions: IHC and molecular analysis on the diagnostic biopsy with stratification of patients into prognostic risk groups already at the preoperative stage could allow personalised management of endometrial cancer surgical therapy.| File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/30711