Rak endometrium – Rokowania, prognozy i postęp choroby

Rak endometrium
Rokowania, prognozy i postęp choroby

Rak endometrium, będący jednym z najczęstszych nowotworów ginekologicznych, charakteryzuje się 5-letnim przeżyciem na poziomie 81% dla wszystkich stopni zaawansowania, a w przypadku choroby ograniczonej do macicy wskaźnik ten wzrasta do 95%. Rokowanie zależy od wielu czynników, w tym stopnia zaawansowania według FIGO (I: 70-95%, III-IV: 10-60%), stopnia zróżnicowania histopatologicznego (G1/G2 lepsze niż G3), głębokości naciekania mięśniówki, typu histologicznego (endometrioidalny lepszy niż surowiczy), obecności komórek nowotworowych w płynie otrzewnowym, wieku pacjentki oraz współistniejącej otyłości i chorób metabolicznych. Nowa klasyfikacja molekularna FIGO 2023 podkreśla znaczenie mutacji POLE (POLEmut) z najlepszym rokowaniem oraz nieprawidłowej ekspresji p53 (p53abn) jako czynnika prognostycznego związanego z gorszym przebiegiem choroby (p=0,009). Dodatkowo, obecność receptorów progesteronowych i markery immunologiczne (GZMK, IL7, GIMAP, UBD) oraz geny związane z autofagią (CDKN2A, PTK6, ERBB2, BIRC5) stanowią istotne biomarkery prognostyczne i potencjalne cele terapeutyczne.

Prognosis raka endometrium (Endometrial cancer)

Tradycyjne czynniki prognostyczne
Molekularne czynniki prognostyczne
Modele prognostyczne w raku endometrium
Wpływ leczenia na rokowanie
Personalizacja podejścia w rokowaniu raka endometrium

Podsumowanie rokowania w raku endometrium

Kolejne rozdziały

Prognosis raka endometrium (Endometrial cancer)

Rak endometrium (rak trzonu macicy) jest jednym z najczęstszych nowotworów ginekologicznych. Mimo że ogólne rokowanie dla większości pacjentek jest dobre, z 5-letnim przeżyciem na poziomie 81% dla wszystkich stopni zaawansowania, istotne jest zrozumienie czynników prognostycznych, które wpływają na przebieg choroby i przeżycie pacjentek¹². W przypadku wczesnego wykrycia choroby (rak ograniczony do macicy), wskaźnik 5-letniego przeżycia może wynosić nawet 95%¹. Jednak około 10-15% pacjentek z rakiem endometrium doświadczy nawrotu choroby, a w tych przypadkach rokowanie jest niekorzystne i większość z tych pacjentek umrze z powodu swojej choroby³.

Tradycyjne czynniki prognostyczne

Rokowanie w raku endometrium zależy od wielu czynników. Do tradycyjnych czynników prognostycznych należą⁴⁵:

Stopień zaawansowania według FIGO – jest jednym z najważniejszych czynników prognostycznych. Pacjentki ze stopniem I mają najlepsze rokowanie z 5-letnim przeżyciem 70-95%, podczas gdy w przypadku stopni III i IV wskaźnik przeżycia spada do 10-60%²⁵.
Stopień zróżnicowania histopatologicznego (grade) – guzy G1 lub G2 mają lepsze rokowanie i mniejsze prawdopodobieństwo nawrotu niż guzy G3⁵.
Głębokość naciekania mięśniówki macicy – głębszy naciek mięśniówki (myometrium) wiąże się z gorszym rokowaniem⁵.
Typ histologiczny – raki endometrioidalne mają lepsze rokowanie niż surowiczy typ raka endometrium. Podobnie mezenchymalne guzy podścieliska endometrium mają lepsze rokowanie niż mięsakoraki⁶.
Obecność komórek nowotworowych w płynie otrzewnowym – często oznacza agresywny charakter nowotworu i wiąże się z gorszym rokowaniem⁶.
Wiek pacjentki – młodsze kobiety mają zazwyczaj lepsze rokowanie niż kobiety po menopauzie, często ze względu na niższy stopień zaawansowania guza i mniejszą głębokość naciekania mięśniówki macicy⁷.
Otyłość i współistniejące choroby – otyłość, zwłaszcza w połączeniu z cukrzycą i nadciśnieniem tętniczym, wiąże się z gorszym rokowaniem⁷.

Molekularne czynniki prognostyczne

W ostatnich latach coraz większe znaczenie zyskuje klasyfikacja molekularna raka endometrium, która została uwzględniona w klasyfikacji FIGO 2023⁸⁹. Badania wykazują, że kategoria molekularna odpowiada różnemu rokowaniu w klinicznym stadium I raka endometrium według nowej klasyfikacji FIGO 2023⁸:

Przypadki z mutacją POLE (POLEmut) – wykazują najlepsze rokowanie⁸⁹.
Przypadki z nieprawidłową ekspresją białka p53 (p53abn) – wiążą się z najgorszym rokowaniem⁸⁹.

Badania potwierdziły, że niezależnymi czynnikami ryzyka nawrotu są: stadium IC (p=0,001), agresywne typy histologiczne raka endometrium (p=0,001) oraz obecność nieprawidłowej ekspresji białka p53 (p=0,009)⁸. Czynniki te były również istotnie związane z niższymi wskaźnikami 5-letniego przeżycia całkowitego¹⁰.

Ponadto, coraz większe znaczenie zyskują również inne markery molekularne związane z rokowaniem w raku endometrium¹¹:

Obecność receptorów progesteronowych na komórkach nowotworowych może być związana z mniej agresywnym nowotworem. Komórki nowotworowe posiadające receptory progesteronowe lepiej reagują na terapię hormonalną i mają korzystniejsze rokowanie⁷.
Markery immunologiczne – geny związane z odpowiedzią immunologiczną w raku endometrium, w tym GZMK, IL7, GIMAP i UBD, mogą służyć jako nowe biomarkery i cele terapeutyczne do oceny poziomu odpowiedzi immunologicznej¹²¹³.
Geny związane z autofagią – zidentyfikowano cztery geny związane z autofagią (CDKN2A, PTK6, ERBB2 i BIRC5) jako niezależne czynniki prognostyczne w raku endometrium¹⁴¹⁵.

Modele prognostyczne w raku endometrium

W celu lepszego przewidywania rokowania u pacjentek z rakiem endometrium opracowano różne modele prognostyczne, które łączą tradycyjne czynniki kliniczne i patologiczne z nowymi markerami molekularnymi¹⁶.

Nomogram MSKCC (Memorial Sloan Kettering Cancer Center)

Nomogram raka endometrium MSKCC jest narzędziem online, które może być używane do przewidywania szansy przeżycia całkowitego po pierwotnym leczeniu raka endometrium¹⁶¹⁷. W przeciwieństwie do tradycyjnej oceny FIGO, nomogram ten uwzględnia również inne czynniki pacjenta, takie jak wiek, histologia, stopień zróżnicowania oraz adekwatność lub dokładność oceny stopnia zaawansowania¹⁶.

Model HECTOR

HECTOR to model prognostyczny oparty na głębokim uczeniu, który wykorzystuje dane multimodalne do przewidywania ryzyka nawrotu odległego w raku endometrium¹⁸. Model ten wykazał wysokie wartości indeksu C w wewnętrznych (0,789) i zewnętrznych (0,828 i 0,815) zestawach testowych, przewyższając obecny złoty standard¹⁸. HECTOR identyfikuje pacjentki o znacząco różnych rokowaniach, z 10-letnim prawdopodobieństwem braku nawrotu odległego wynoszącym 97,0%, 77,7% i 58,1% odpowiednio dla grup niskiego, średniego i wysokiego ryzyka¹⁸.

IRSM to model prognostyczny oparty na genach związanych z odpowiedzią immunologiczną, który może służyć jako niezależny predyktor złego rokowania dla pacjentek z rakiem endometrium¹⁹²⁰. Model ten wykazuje wysoką wartość predykcyjną dla odpowiedzi na immunoterapię i chemioterapię²⁰.

W podobnym badaniu opracowano model ryzyka oparty na genach związanych z odpowiedzią immunologiczną (GZMK, IL7, GIMAP i UBD) dla raka trzonu macicy¹². Wartości AUC dla krzywej ROC po 1, 3 i 5 latach wynosiły odpowiednio 0,701, 0,710 i 0,710, co wskazuje na doskonałą zdolność predykcyjną modelu dla przeżycia pacjentek z rakiem endometrium²¹.

Model TR-MAMIL

TR-MAMIL to model głębokiego uczenia do klasyfikacji raka endometrium i przewidywania obciążenia mutacyjnego guza (TMB) na podstawie slajdów histopatologicznych²². Model ten osiągnął doskonałe wyniki w klasyfikacji agresywnego i nieagresywnego raka endometrium, z wartościami 97%, 93%, 89% i 89% odpowiednio dla obszaru pod krzywą ROC, czułości, średniej czułości i swoistości oraz dokładności²³. Analiza Kaplana-Meiera wykazała, że TR-MAMIL skutecznie różnicuje pacjentki z dłuższym przeżyciem swoistym dla choroby i przeżyciem całkowitym²².

Nomogram z markerami immunohistochemicznymi

Opracowano nomogram do przewidywania nawrotu raka endometrium na podstawie markerów immunohistochemicznych i parametrów kliniczno-patologicznych²⁴. Analiza wieloczynnikowa wykazała, że stadium FIGO, typ histologiczny, receptor estrogenowy (ER) i p53 są najlepszymi parametrami do generowania modelu nomogramu do przewidywania nawrotu w raku endometrium²⁴. Przeżycie wolne od nawrotu było lepiej przewidywane przez proponowany nomogram, z wartością indeksu C wynoszącą 0,79 (95% CI 0,66-0,92) w kohorcie walidacyjnej²⁴.

Nomogram dla zaawansowanego raka endometrium

Opracowano i zwalidowano nomogram prognostyczny do przewidywania przeżycia swoistego dla raka (CSS) po operacji u pacjentek z zaawansowanym rakiem endometrium²⁵. Nomogram ten obejmuje 10 zmiennych: dodatnie węzły regionalne, wiek, wielkość guza, stadium FIGO, stopień zróżnicowania, pochodzenie etniczne, dochód, radioterapię, chemioterapię i stadium historyczne²⁵. Według tego nomogramu, stadium FIGO odgrywa największą rolę w rokowaniu, a następnie stopień zróżnicowania guza i wiek w momencie diagnozy²⁶.

Wpływ leczenia na rokowanie

Leczenie raka endometrium ma istotny wpływ na rokowanie pacjentek²⁷:

Kluczowym elementem leczenia raka endometrium jest usunięcie macicy (histerektomia)²⁷.
Pacjentki leczone przez doświadczone zespoły, które często zajmują się przypadkami raka endometrium, mają lepsze wyniki niż pacjentki leczone przez chirurgów, którzy rzadko zajmują się takimi przypadkami²⁷.
Wskaźniki przeżycia w raku endometrium poprawiły się z czasem dzięki dokładniejszym badaniom, diagnozie i ocenie stopnia zaawansowania choroby, poprawie szybkości skierowania, dostępności wytycznych opartych na dowodach oraz postępom w chirurgii²⁷.

Po operacji raka endometrium i po konsultacji z onkologiem ginekologicznym ważne jest opracowanie planu kontroli, który czasami może trwać do pięciu lat²⁷. Po pięciu latach ryzyko nawrotu staje się znikomo małe²⁷.

Personalizacja podejścia w rokowaniu raka endometrium

Nowoczesne badania podkreślają znaczenie personalizacji podejścia do oceny rokowania i leczenia pacjentek z rakiem endometrium⁸¹¹:

Optymalna stratyfikacja ryzyka we wczesnych stadiach raka endometrium łączy cechy molekularne i kliniczno-patologiczne⁸.
Biomarkery prognostyczne pomagają klinicystom stratyfikować pacjentki do różnych grup ryzyka i kierować decyzjami terapeutycznymi, takimi jak intensywność terapii adjuwantowej i częstotliwość nadzoru¹¹.
Integracja biomarkerów prognostycznych w praktyce klinicznej umożliwia spersonalizowane zarządzanie pacjentkami z rakiem endometrium w oparciu o ich indywidualne czynniki ryzyka¹¹.

Podsumowanie rokowania w raku endometrium

Rak endometrium jest jednym z najczęstszych nowotworów ginekologicznych o stosunkowo dobrym rokowaniu, zwłaszcza gdy zostanie wykryty we wczesnym stadium¹. Ogólny wskaźnik 5-letniego przeżycia wynosi 81%, przy czym wskaźnik ten wzrasta do 95% w przypadku nowotworów, które nie rozprzestrzeniły się poza macicę¹. Rokowanie zależy od wielu czynników, w tym stadium zaawansowania, stopnia zróżnicowania, głębokości naciekania mięśniówki macicy, typu histologicznego oraz obecności markerów molekularnych⁵⁶.

Postępy w zrozumieniu molekularnych podstaw raka endometrium doprowadziły do opracowania nowych modeli prognostycznych, które mogą lepiej przewidywać przebieg choroby i odpowiedź na leczenie¹⁸²⁰. Te nowe modele, łączące tradycyjne czynniki kliniczne i patologiczne z biomarkerami molekularnymi, oferują bardziej spersonalizowane podejście do zarządzania pacjentkami z rakiem endometrium¹¹.

Należy jednak pamiętać, że wskaźniki przeżycia są jedynie wskazówką i nie mogą przewidzieć dokładnie, jak długo dana pacjentka będzie żyła z chorobą²⁸. Dokładne zrozumienie rokowania dla kobiet z rakiem endometrium po operacji może pomóc lekarzom i pacjentkom w wyborze terapii uzupełniających, takich jak chemioterapia, radioterapia i terapia hormonalna¹⁶.

Kolejne rozdziały

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Materiały źródłowe

#1 Uterine Cancer (Endometrial Cancer): Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/16409-uterine-cancer
The five-year survival rate for endometrial cancer is 81%. That means 81% of women diagnosed with the disease are alive five years later. The rate is even higher when cancer hasnt spread outside your uterus. Then, the survival rate reaches as high as 95%. Treatments continue to improve, along with survival rates. Uterine cancer is fatal when it goes undiagnosed and spreads. The survival rate decreases to 17% when cancer spreads to other parts of your body outside your uterus. Early detection and early treatment are key to a favorable prognosis. […] Fortunately, endometrial cancer is often diagnosed at an early stage. Thats because many people notice unusual bleeding and tell their healthcare providers. If cancer gets caught early and hasnt spread to other organs, removing your uterus can cure it.
#2 Endometrial Cancer – Gynecology and Obstetrics – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/gynecology-and-obstetrics/gynecologic-tumors/endometrial-cancer
Prognosis is worse with higher-grade tumors, more extensive spread, and older patient age. […] Average 5-year survival rates for patients with endometrial cancer are (1) Stage I or II: 70 to 95% […] Stage III or IV: 10 to 60%. […] Overall, 63% of patients are cancer-free 5 years after treatment. […] Prognosis is better with type I tumors, which are grade 1 or 2 endometrioid adenocarcinomas; they tend to be estrogen-responsive and diagnosed at a younger age.
#3 Prognostic models for predicting recurrence and survival in women with endometrial cancer
https://pmc.ncbi.nlm.nih.gov/articles/PMC8202229/
To review all prognostic models that combine two or more clinical, histological or molecular variables, or a combination of these variables, to provide an individualised assessment of risk of recurrence or death from disease and evaluate their performance to predict these outcomes in people undergoing curative treatment for endometrial cancer. […] The outlook for most people diagnosed with endometrial cancer is good. The majority (70%) will present when the cancer is still confined to the womb (i.e. early-stage disease) and will be completely cured of their disease. Even when all stages of endometrial cancer are considered, nearly 80% of people affected can expect to survive for at least five years after their diagnosis, if they live in a high-income countries (ONS 2016). […] However, approximately 10% to 15% of people with endometrial cancer will develop a recurrence (Bendifallah 2017; Salani 2017). The prognosis for those that develop recurrence is poor and most of these people will die from their disease (Bendifallah 2017). […] This review aims to evaluate the comparative performance of all current prognostic models to predict recurrence and survival in those receiving curative treatment for endometrial cancer.
#4 Prognosis and survival for uterine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/uterine/prognosis-and-survival
If you have uterine cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
#5 Prognosis and survival for uterine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/uterine/prognosis-and-survival
The following are prognostic and predictive factors for uterine cancer. […] Grade is one of the more important prognostic factors. Grade 1 or 2 tumours have a better prognosis and are less likely to recur than Grade 3 tumours. […] Myometrial invasion is how far the tumour has grown into, or invaded, the middle layer of the uterus wall (called the myometrium). Doctors can use the degree of myometrial invasion to predict if the cancer will come back, or recur, and to predict survival. The deeper the tumour has grown into the myometrium, the poorer the prognosis. […] Stage 1 cancers have the most favourable prognosis. Cancers have a less favourable prognosis if they have spread outside of the uterus, including to the following: lymph nodes, cervix, structures in the pelvis and abdomen (also known as extra-uterine disease).
#6 Prognosis and survival for uterine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/uterine/prognosis-and-survival
Endometrial carcinomas have a more favourable prognosis than uterine sarcomas. Some types of tumours within these groups have more favourable prognoses than others. For example, endometrioid carcinomas have a more favourable prognosis than serous adenocarcinomas. Also, endometrial stromal sarcomas have a more favourable prognosis than uterine leiomyosarcomas. […] When cancer cells are in the fluid in the abdominal cavity (called peritoneal fluid), it often means that the cancer has spread outside the uterus. This prognostic factor is often linked with other factors, such as how deep the tumour has grown into the myometrium and if the cancer has spread to lymph nodes. Cancer cells in the peritoneal fluid (called positive peritoneal cytology) often means the cancer is more aggressive and it has a less favourable prognosis.
#7 Prognosis and survival for uterine cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/uterine/prognosis-and-survival
The presence of progesterone receptors on the cancer cells may be linked with a less aggressive cancer. Cancer cells that have progesterone receptors have a better response to hormonal therapy and a more favourable prognosis. […] Younger women tend to have a better prognosis than post-menopausal women. This is true even though younger women may not be diagnosed with uterine cancer based on their symptoms as quickly as older women. Younger women often have lower grade tumours that are found at an earlier stage and havent grown very deep into the myometrium. Older women often have a more aggressive type of tumour and more advanced disease. As a result, older women tend to have a less favourable prognosis. […] Obesity, especially when the woman also has diabetes and high blood pressure, has been linked with a less favourable prognosis.
#8 Prognosis of Stage I Endometrial Cancer According to the FIGO 2023 Classification Taking into Account Molecular Changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10813919/
Optimum risk stratification in the early stages of endometrial cancer combines molecular and clinicopathological features. […] The purpose of the study was to determine the prognostic value of molecular classification and traditional pathological factors in a sample group of patients with stage I endometrial cancer according to the FIGO 2023 criteria to achieve a more personalized approach to patient care and treatment. […] Our research studies confirm that molecular category corresponds to a different prognosis in clinical stage I EC according to the new 2023 FIGO classification, with POLEmut cases presenting the best outcomes and p53abn cases showing the worst outcomes. […] It has been shown that the independent recurrence risk factors are stage IC (p 0.001), aggressive histological types EC (p 0.001), and the presence of p53abn protein immunoexpression (p = 0.009).
#9 Retrospective Analysis of Molecular Markers in Endometrial Cancer: Single Center Experience
https://www.imrpress.com/journal/CEOG/51/2/10.31083/j.ceog5102043/htm
Background: To emphasize the effect of molecular markers on prognosis in endometrial cancer, in addition to the International Federation of Gynecology and Obstetrics (FIGO) 2009 classification. […] Our study shows the prognostic value of the molecular endometrial cancer classification. Patients with p53mut have a poor progression-free survival, POLEmut endometrial cancer have a good prognosis. […] Molecular classification of endometrial cancer has become important with the FIGO 2023 staging system. We wanted to retrospectively screen and present molecularly classified endometrial cancer cases in our clinic. Our study shows the clinical impact of molecular EC classification in addition to grade and histopathological type in endometrial cancer. Patients with p53mut have a poor PFS, POLEmut EC have a good prognosis. In this study, we wanted to demonstrate the importance of molecular markers in endometrium cancer and their contribution to prognosis.
#10 Prognosis of Stage I Endometrial Cancer According to the FIGO 2023 Classification Taking into Account Molecular Changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10813919/
Stage IC (p = 0.018), aggressive histological types EC (p = 0.025) and the presence of p53abn protein immunoexpression (p = 0.010) were all significantly associated with lower 5-year OS rates. […] The independent risk factors are stage IC (HR = 3.01, 95% CI 1.976.94, p 0.001), aggressive histological types EC (HR = 2.86, 95% CI 1.735.25, p 0.001), and the presence of p53abn protein immunoexpression (HR = 3.49, 95% CI 1.116.34, p = 0.011). […] For OS, stage IC, aggressive histological types EC, and the presence of p53abn protein immunoexpression were all significantly associated with lower 5-year OS rates. […] The findings from our research investigations corroborate the premise that within the clinical stage I endometrial cancer (EC), as per the recently updated 2023 FIGO classification, distinct prognostic outcomes are inherently tied to specific molecular subtypes. Notably, cases exhibiting POLE mutations (POLEmut) demonstrate the most favorable prognostic outcomes. Conversely, cases characterized by p53 abnormalities (p53abn) are associated with the least favorable prognoses.
#11 Landscape of Endometrial Cancer: Molecular Mechanisms, Biomarkers, and Target Therapy
https://www.mdpi.com/2072-6694/16/11/2027
Endometrial cancer is one the most prevalent gynecological cancers and, unfortunately, has a poor prognosis due to low response rates to traditional treatments. […] The connection between molecular biomarkers and targeted therapy is vital in the fight against cancer. Ongoing research and clinical trials are exploring the use of standard therapy agents in combination with other treatment strategies like immunotherapy and anti-angiogenesis therapy to improve outcomes and personalize treatment for patients with endometrial cancer. […] In conclusion, enhancing molecular tools is essential for stratifying the risk and guiding surgery, adjuvant therapy, and cancer treatment for women with endometrial cancer. […] Prognostic biomarkers help clinicians stratify patients into different risk groups and guide treatment decisions, such as the intensity of adjuvant therapy and the frequency of surveillance. Integrating prognostic biomarkers into clinical practice enables personalized management of endometrial cancer patients based on their individual risk factors.
#12 Risk prediction model of uterine corpus endometrial carcinoma based on immune-related genes | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03237-2
Given the significant role of immune-related genes in uterine corpus endometrial carcinoma (UCEC) and the long-term outcomes of patients, our objective was to develop a prognostic risk prediction model using immune-related genes to improve the accuracy of UCEC prognosis prediction. […] The analysis of the survival nomogram indicated that the model has excellent predictive ability and strong reliability for predicting the survival of patients with UCEC. […] This further revealed that GZMK, IL7, GIMAP, and UBD could potentially serve as biomarkers associated with immune levels in endometrial cancer. […] The study identified genes related to immune response in UCEC, including GZMK, IL7, GIMAP, and UBD, which may serve as new biomarkers and therapeutic targets for evaluating immune levels in the future.
#13 Risk prediction model of uterine corpus endometrial carcinoma based on immune-related genes | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03237-2
The results indicated significant differences in survival and immune function, which showed varying correlations with clinical indicators. […] Using the prognostic model developed in this study, we can enhance predictions for patients with endometrial cancer based on the key genes GZMK, IL7, GIMAP, and UBD.
#14 An integrated autophagy-related gene signature predicts prognosis in human endometrial Cancer | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07535-4
Globally, endometrial cancer is the fourth most common malignant tumor in women and the number of women being diagnosed is increasing. […] We explored the relationship between endometrial cancer prognoses and the expression of autophagy genes using human autophagy databases. […] A prognostic model for endometrial cancer was constructed using univariate and multivariate Cox, and Least Absolute Shrinkage and Selection Operator regression analysis. […] KaplanMeier survival analysis suggested that high-risk groups have significantly shorter survival times than low-risk groups. […] Our prognostic model assessing four ARGs (CDKN2A, PTK6, ERBB2, and BIRC5) suggested their potential as independent predictive biomarkers and therapeutic targets for endometrial cancer. […] The relationship between autophagy and the occurrence and development of endometrial cancer has been reported in the early studies, for example, autophagy-mediated regulation of the adaptive response to targeted therapy.
#15 An integrated autophagy-related gene signature predicts prognosis in human endometrial Cancer | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/s12885-020-07535-4
In the present study, we found that BIRC5 was significantly overexpressed in endometrial cancer and an independent prognostic factor, suggesting that BIRC5 might promote endometrial cancer by inhibiting autophagy in cancer cells. […] In summary, by collecting and analyzing the transcript information of endometrial cancer samples from TCGA database, we identified four prognosis-associated autophagy genes (CDKN2A, PTK6, ERBB2, and BIRC5).
#16 Prediction Tools for Uterine (Endometrial) Cancer | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/cancer-care/types/uterine-endometrial/prediction-tools
Our endometrial cancer nomogram is an online tool that can be used to predict the chance of overall survival following primary therapy for endometrial cancer, sometimes also called uterine cancer. […] An accurate understanding of prognosis for women with endometrial cancer after surgery can help guide doctors and patients in their choice of follow-up therapies such as chemotherapy, radiation, and hormone therapy. […] Traditionally in endometrial cancer, doctors have relied mainly on the final International Federation of Gynecology and Obstetrics (FIGO) staging assessment to estimate overall outcome. However, it is well known that other patient factors such as age, histology (the specific subtype of endometrial cancer assigned after pathology analysis), final grade (the percentage of an endometrial tumor that is solid), and adequacy or accuracy of staging (a system that identifies the extent to which the cancer has spread) may play equally important roles in prognosis and overall outcome. This nomogram takes these other factors into account. […] To better understand the results of the nomogram, patients should discuss survival estimates with their doctors.
#17 Endometrial Cancer Nomogram: Overall Survival Probability Following Surgery | Memorial Sloan Kettering Cancer Center
https://www.mskcc.org/nomograms/endometrial/post_op
Our endometrial cancer nomogram is a tool designed to predict the likelihood of survival at one year, three years, and five years after undergoing surgery to remove the endometrial (uterine) cancer. […] Results produced by this tool are based on data from patients treated at MSK, a large research institution with surgeons who perform a high volume of uterine cancer procedures. […] Probability of surviving after surgery to remove endometrial cancer. […] A nomogram for predicting overall survival of women with endometrial cancer following primary therapy: toward improving individualized cancer care. […] Independent external validation of radiotherapy and its impact on the accuracy of a nomogram for predicting survival of women with endometrial cancer. […] External validation of a nomogram predicting overall survival of patients diagnosed with endometrial cancer.
#18 Prediction of recurrence risk in endometrial cancer with multimodal deep learning | Nature Medicine
https://www.nature.com/articles/s41591-024-02993-w
Predicting distant recurrence of endometrial cancer (EC) is crucial for personalized adjuvant treatment. […] HECTOR demonstrated C-indices in internal (n=353) and two external (n=160 and n=151) test sets of 0.789, 0.828 and 0.815, respectively, outperforming the current gold standard, and identified patients with markedly different outcomes (10-year distant recurrence-free probabilities of 97.0%, 77.7% and 58.1% for HECTOR low-, intermediate- and high-risk groups, respectively, by Kaplan-Meier analysis). […] HECTOR also predicted adjuvant chemotherapy benefit better than current methods. […] HECTOR improves on the current gold standard and may help delivery of personalized treatment in EC. […] HECTOR showed strong prognostic value as a continuous variable in the training test set (HR=5.06; 95% CI: 4.355.89; P=9.001099), the internal test set (HR=2.69; 95% CI: 2.073.49; P=1.311013) and the UMCG external test set (HR=5.84; 95% CI: 3.0611.14; P=8.37108).
#19 Prediction of Prognosis, Immunotherapy and Chemotherapy with an Immune-Related Risk Score Model for Endometrial Cancer
https://www.mdpi.com/2072-6694/15/14/3673
Prediction of Prognosis, Immunotherapy and Chemotherapy with an Immune-Related Risk Score Model for Endometrial Cancer […] Endometrial cancer (EC) is one of the most common gynecologic cancers. However, its clinical therapy remains unsatisfying due to the lack of effective treatment screening approaches. […] The overall survival remains unsatisfying due to the lack of effective treatment screening approaches. Immunotherapy as a promising therapy has been applied for EC treatment, but still fails in many cases. Therefore, there is a strong need to optimize the screening approach for clinical treatment. […] The IRSM was proved effective as an independent predictor of poor prognosis. […] Overall, we developed an IRSM which could be used to predict the prognosis, immunotherapy response and chemotherapy sensitivity of EC patients.
#20 Prediction of Prognosis, Immunotherapy and Chemotherapy with an Immune-Related Risk Score Model for Endometrial Cancer
https://www.mdpi.com/2072-6694/15/14/3673
The IRSM could serve as a poor-prognosis predictor for EC patients. […] The IRSM was found to be an independent predictor of poor prognosis. […] The IRSM also showed a high predictive value for immunotherapy and chemotherapy response. […] Our analysis not only will help optimize personalized treatments but also provides a deeper understanding of endometrial cancer progression.
#21 Risk prediction model of uterine corpus endometrial carcinoma based on immune-related genes | BMC Women’s Health | Full Text
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-024-03237-2
The Immune-Related Risk Score Model (IRSM) is an independent predictor of adverse prognosis and reflects patient sensitivity to chemotherapy. […] The risk coefficients for these genes are negative. Additionally, ITGA7, APOBEC3G, GIMAP7, PLAUR, CLEC10A, IRF8, PIK3CG, IL7, SLAMF8, IL32, PIGR, IL20RA, ENTPD3, RORA, TCF4, and BMP4 have positive risk coefficients. […] The AUC values for neutron patients in the ROC curve at 1, 3, and 5 years were 0.701, 0.710, and 0.710, respectively. These values indicate that the model has excellent predictive ability for the survival of patients with UCEC. […] The survival of patients in the high- and low-risk groups was significantly different, and the expression of model genes in the validation set was consistent with the data expression in the analysis set.
#22 Deep learning for endometrial cancer subtyping and predicting tumor mutational burden from histopathological slides | npj Precision Oncology
https://www.nature.com/articles/s41698-024-00766-9
Endometrial cancer (EC) diagnosis traditionally relies on tumor morphology and nuclear grade, but personalized therapy demands a deeper understanding of tumor mutational burden (TMB), i.e., a key biomarker for immune checkpoint inhibition and immunotherapy response. […] TR-MAMIL performed exceptionally well in classifying aggressive and non-aggressive EC, as well as predicting TMB, outperforming seven state-of-the-art approaches. […] KaplanMeier analysis further demonstrated TR-MAMIL’s ability to differentiate patients with longer survival in the aggressive EC. […] High TMB (TMB-H) has been associated with improved patient response rates and survival benefits from ICIs, making it a promising predictive biomarker for immunotherapy. […] Importantly, according to the KaplanMeier survival analysis, the results show that TR-MAMIL successfully differentiates patients with longer disease-specific survival (DSS) and overall survival (OS) with significant difference (p<0.01 for DSS, p<0.05 for OS) between the TMB predicted classes in the aggressive EC.
#23 Deep learning for endometrial cancer subtyping and predicting tumor mutational burden from histopathological slides | npj Precision Oncology
https://www.nature.com/articles/s41698-024-00766-9
These compelling findings highlight the potential of TR-MAMIL to guide personalized treatment decisions by accurately predicting the EC cancer subtype and the TMB status for effective immunotherapy planning for EC patients. […] The identification of TMB, i.e. an established predictive biomarker for cancer immunotherapy, has further enhanced the precision of treatment strategies as TMB provides precise and comprehensive information for determining the efficacy of immunotherapies in EC. […] TR-MAMIL achieved outstanding performance in the classification of the aggressive and non-aggressive EC, with 97%, 93%, 89%, and 89% for the area under the receiver operating characteristic curve (AUROC), sensitivity, mean of sensitivity and specificity (MeanSS) and accuracy, respectively. […] These compelling findings highlight the potential of TR-MAMIL to guide personalized treatment decisions by accurately predicting the EC cancer subtype and the TMB status for effective immunotherapy planning for EC patients.
#24 Predicting Recurrence in Endometrial Cancer Based on a Combination of | CMAR
https://www.dovepress.com/predicting-recurrence-in-endometrial-cancer-based-on-a-combination-of–peer-reviewed-fulltext-article-CMAR
Objective: The aim of this study was to establish a nomogram to predict the recurrence of endometrial cancer (EC) by immunohistochemical markers and clinicopathological parameters and to evaluate the discriminative power of this model. […] Univariate analysis found that FIGO stage, histological type, histological grade, myometrial invasion, cervical stromal invasion, postoperative adjuvant treatment, and four immunohistochemical markers (Ki67, ER, PR, and p53) were associated with recurrence in EC. Multivariate analysis showed that FIGO stage, histological type, ER, and p53 were superior parameters to generate the nomogram model for recurrence prediction in EC. Recurrence-free survival was better predicted by the proposed nomogram, with a C-index value of 0.79 (95% CI 0.66 0.92) in the validation cohort.
#25 Development and validation of a prognostic nomogram for predicting cancer-specific survival in advanced endometrial carcinoma after surgery: a retrospective analysis of the SEER Database | BMJ Open
https://bmjopen.bmj.com/content/13/9/e070893
Objective We aimed to construct and validate a prognostic nomogram to predict cancer-specific survival (CSS) after surgery in patients with advanced endometrial carcinoma (EC). […] The nomograms for CSS included 10 variables (positive regional nodes, age, tumour size, International Federation of Gynecology and Obstetrics (FIGO) stage, grade, ethnicity, income, radiation, chemotherapy and historical stage) based on the forward stepwise regression results. […] We successfully constructed an accurate and effective nomogram to predict CSS in patients with advanced EC, which may help clinicians determine optimal individualised treatment strategies for patients with advanced EC. […] The predictive performance of the nomogram was evaluated thoroughly, but only internally. Therefore, further validation using different data sources is warranted in future related studies.
#26 Development and validation of a prognostic nomogram for predicting cancer-specific survival in advanced endometrial carcinoma after surgery: a retrospective analysis of the SEER Database | BMJ Open
https://bmjopen.bmj.com/content/13/9/e070893
In this study, we aimed to establish an effective and non-invasive nomogram to predict cancer-specific survival (CSS) in advanced EC following surgery, incorporating advanced statistical methodologies. […] The results showed that ethnicity, chemotherapy, historical stage, grade, radiation, FIGO stage, age at diagnosis, tumour size, positive regional nodes and income were independent prognostic factors in this patient group. […] According to the nomogram, the FIGO stage plays the largest role in prognosis, followed by tumour grade and age at diagnosis. […] This nomogram is highly effective in identifying high-risk groups owing to its poor prognosis. Patients with a total score greater than 285 should receive special attention. […] Our nomogram is more accurate, has better clinical utility and provides better prognostic predictions than FIGO staging for patients with advanced EC after surgery.
#27 Survival Rate for Endometrial Cancer » Professor Andreas Obermair
https://www.obermair.info/latest-news/blog/what-is-the-survival-rate-for-endometrial-cancer/
Research also has shown that patients treated by experienced teams who manage endometrial cancer patients frequently, do better than patients managed by surgeons who only see a few endometrial cancer patients in their lifetime. […] Survival rates for endometrial cancer have improved over time due to more accurate investigation, diagnosis and staging of disease, improvements in the speed of referral, availability of evidence-based guidelines, and advances in surgery. […] The key to successful endometrial cancer treatment is the removal of the uterus (hysterectomy). […] After surgery for endometrial cancer and after discussion with your gynaecological oncologist, it is important to make a plan for follow up, which sometimes can be for up to five years. After five years, the risk of a recurrence becomes negligibly low. More importantly, patients need to be aware of the signs of recurrence. […] Survival rates are a guide only and you may have worries or questions. A gynaecological oncologist can discuss how these estimates apply to you.
#28 Survival Rate for Endometrial Cancer » Professor Andreas Obermair
https://www.obermair.info/latest-news/blog/what-is-the-survival-rate-for-endometrial-cancer/
Numbers of patients diagnosed with endometrial cancer are increasing, with Cancer Australia estimating over 3,000 cases and 400 deaths per year in Australia. Upon an endometrial cancer diagnosis I am commonly asked: What is the likelihood that I will survive this cancer? […] Relative survival rates provide an estimate of what percentage of people with the same cancer are alive for benchmarking we normally report data at five years after the initial diagnosis of cancer, compared to healthy people of the same age and sex in the general population. […] Survival rates will not tell you how long you may live (this would be virtually impossible to predict), but can be used as an indicator of the successfulness of treatments. […] In 2012-2016, females diagnosed with all types and stages of endometrial cancer combined had an overall 85% chance of surviving for five years compared to the general Australian population.