AUTHOR=Dai Yibo , Wang Jingyuan , Zhao Luyang , Wang Zhiqi , Wang Jianliu 

TITLE=Tumor Molecular Features Predict Endometrial Cancer Patients’ Survival After Open or Minimally Invasive Surgeries

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.634857

DOI=10.3389/fonc.2021.634857

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>The Cancer Genome Atlas (TCGA) project shed light on the vital role of tumor molecular features in predicting endometrial cancer patients’ prognosis. This study aims to investigate the survival impact of surgical approaches on patients with different genetic alterations.</p></sec><sec><title>Methods</title><p>473 endometrial cancer patients from TCGA database were selected. To analyze the prognostic impact of surgical approach, survival analyses were conducted in patients with different molecular features. Finally, a simplified molecular stratification model was established to select patients suitable for open or minimally invasive surgery (MIS).</p></sec><sec><title>Results</title><p>In our cohort, 291 patients received open surgery and 182 received MIS. Molecular features influenced patients’ survival after different surgical approaches. Based on survival analyses, three molecular subtypes were generated, with subtype 1 harboring <italic>POLE</italic> mutation (<italic>POLE<sup>mt</sup></italic>), microsatellite-instability high (MSI-H), homologous recombination repair (HRR) pathway mutation or <italic>MUC16</italic> mutation (<italic>MUC16<sup>mt</sup></italic>); subtype 3 carrying <italic>TP53</italic> mutation; and subtype 2 without specific molecular feature. The survival influence of molecular subtypes depended on surgical approaches. In the open surgery cohort, three subtypes showed similar survival outcome, while in the MIS cohort, prognosis varied significantly among three subtypes, with subtype 1 the best and subtype 3 the worst. In stepwise Cox regression, molecular subtype was an independent predictor of recurrence-free survival in patients receiving MIS (<italic>p</italic> &lt; 0.001).</p></sec><sec><title>Conclusion</title><p>The molecular features of endometrial cancer are associated with patients’ prognosis after different surgical approaches. MIS should be recommended in patients with <italic>POLE<sup>mt</sup></italic>, MSI-H, HRR pathway mutation or <italic>MUC16<sup>mt</sup></italic>, while for patients with <italic>TP53</italic> mutation, open surgery is better concerning oncological safety.</p></sec>