The 2023 ESGO/ESTRO/ESP molecular classification of endometrial carcinoma identifies four molecular subgroups with distinct prognoses. The subgroup with the BEST prognosis regardless of histological grade or stage is:

• A Mismatch repair deficient (MMRd)
• B POLE (exonuclease domain) ultramutated ✓
• C p53 abnormal (p53abn)
• D No specific molecular profile (NSMP)

Explanation

The four TCGA-derived molecular subgroups of endometrial carcinoma are: (1) POLE ultramutated — best prognosis, >95% 5-year survival even in high-grade disease; (2) MMRd — intermediate prognosis, high response to immune checkpoint inhibitors; (3) NSMP — intermediate prognosis; (4) p53 abnormal — worst prognosis, includes most serous carcinomas. POLE ultramutation creates a hypermutated immunogenic phenotype that responds well to immune surveillance, explaining the paradoxically excellent prognosis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.