The 2023 FIGO staging of endometrial carcinoma introduced molecular classification. A patient with endometroid endometrial carcinoma and POLE (polymerase epsilon) ultramutated genotype has which prognosis compared to other molecular subtypes?
- A Best prognosis regardless of histological grade or stage ✓
- B Worst prognosis due to hypermutability and treatment resistance
- C Intermediate prognosis, similar to microsatellite-stable tumors
- D Prognosis equivalent to p53-mutant (NSMP) subtype
Correct answer: A. Best prognosis regardless of histological grade or stage
Explanation
The ProMisE (Proactive Molecular Risk Classifier for Endometrial Cancer) molecular classification divides endometrial cancer into 4 groups: POLE ultramutated (best prognosis), MMRd/MSI-H (intermediate), NSMP (copy number low, intermediate), and p53-mutant/TCGA copy number high (worst prognosis). POLE-ultramutated tumors have exceptionally good outcomes (>95% 5-year disease-specific survival) regardless of histological grade, enabling de-escalation of adjuvant therapy. This formed the basis of FIGO 2023 incorporating molecular data into staging.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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