The ProMisE molecular classification of endometrial cancer identifies 4 prognostic groups. A tumour with mutated p53 (p53abn) by immunohistochemistry belongs to which molecular subgroup and what is its prognosis?
- A POLE-ultramutated; excellent prognosis
- B Mismatch repair deficient (MMRd); intermediate prognosis
- C p53-abnormal (p53abn); worst prognosis, similar to serous carcinoma ✓
- D No specific molecular features (NSMP); intermediate prognosis
Explanation
The ProMisE/TCGA molecular classification identifies four endometrial cancer groups: (1) POLE-ultramutated (best prognosis, paradoxically high grade but excellent outcomes), (2) MMR-deficient/MSI-high (intermediate-good prognosis, Lynch-associated), (3) No Specific Molecular Profile — NSMP/copy-number-low (intermediate prognosis), and (4) p53-abnormal/copy-number-high (worst prognosis — similar to serous carcinoma, highly aggressive). p53abn tumours often include high-grade serous and Grade 3 endometrioid cancers and have the poorest survival outcomes. This classification is being incorporated into FIGO 2023 staging.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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