The ESGO/ESTRO/ESP guidelines for endometrial cancer published in November 2020 in the International Journal of Gynaecological Cancer gave us a trailblazing guide to steer our wheels in the precisely carved direction for the treatment of endometrial cancer, the commander being the molecular markers(TP53, MSH6, PMS2 and POLE mutation). Since the complete molecular profiling is not feasible in a low middle income country like India we started getting the tissues of endometrial carcinoma tested for TP53 mutation because its mutation can label even a low risk disease to high risk disease, worsening the treatment outcomes.
This study was conducted in a tertiary care hospital in North India where we have enrolled seven patients till now, with non- metastatic Type I endometrial cancer. The small number of patients is because of low incidence of endometrial cancer in India. All the patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node dissection. The post operative specimen was tested for Tp53 mutation.
The post operative histopathology details are listed in the table. The adjuvant treatment was given as per the ESGO/ESTRO/ESP 2020 guidelines. It was astonishing to observe that TP53 mutation status changed the risk stratification and hence the adjuvant treatment in around 71% patients. A-Absent, P-Present
Patient no. Age of the patient Stage Grade Lvsi Pni Risk stratification without molecular testing Tp53 Risk stratification after molecular testing 1 74 IB Low A A Intermediate Mutation High 2 28 IB Low A A Intermediate Mutation High 3 39 IB Low A A Intermediate Wild-type Intermediate 4 67 IB Low P P Intermediate Mutation High 5 75 IB High A A High-intermediate Mutation High 6 39 IA Low A A Low Mutation High 7 61 IB High A A High-intermediate Wild-type High-intermediate
In resource limited situations TP53 mutation alone and not the complete molecular profile can be the headman guiding the adjuvant treatment of endometrial cancer.
The authors.
Has not received any funding.
All authors have declared no conflicts of interest.