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<p>The distinction between endometrioid endometrial carcinoma (EEC) and serous endometrial carcinoma (SEC) is critical for treatment, but this proves difficult in poorly differentiated tumors. Molecular classification systems have been studied to streamline this task. TP53 mutations are associated with poor prognosis and aggressive behavior and are informally named “serous-like.” This study aims to compare the 2-year survival of high-grade EEC patients with TP53 mutations to those with SEC and to evaluate the prognostic implications of TP53 abnormalities.&#xa0;A retrospective cohort study was conducted on 62 patients with grade 3 EEC (<i>n</i> = 29) or SEC (<i>n</i> = 33) at Quaem Hospital, Mashhad, Iran, from March 2018 to December 2022. TP53 and mismatch repair status were determined using surrogate immunohistochemistry. Demographic data, clinical characteristics, and survival outcomes were analyzed. Kaplan–Meier survival curves and Cox proportional hazards regression models were used to assess 2-year overall survival (OS) and recurrence-free survival (RFS).&#xa0;Baseline characteristics were comparable, except for endometrial thickness, which was higher in EEC patients (<i>p</i> = 0.002). No significant differences were observed in 2-year OS (EEC3: 69% vs. SEC: 58%, <i>p</i> = 0.49) or local failure rates (EEC3: 31% vs. SEC: 29%, <i>p</i> = 0.870) between the two groups. Multivariate analysis identified CA-125 levels as a significant predictor of OS (HR = 1.00, 95% CI 1.001–1.005, <i>p</i> = 0.008).&#xa0;High-grade EEC with TP53 mutations exhibits a similarly unfavorable prognosis to SEC, which can be used to inform more intensive treatment strategies. Routine p53 immunohistochemistry testing is recommended to improve risk stratification and guide personalized treatment strategies, particularly in diagnostically challenging cases.</p>

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Comparable Survival of Grade 3 Endometrioid and Serous Endometrial Carcinoma, with TP53 Mutations

  • 期刊论文

  • 发表日期：

    2025年7月24日

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  • Maryam Esmaeilpour,
  • Mohammad Mahdi Kakoienejad,
  • Malihe Hasanzadeh,
  • Marjaneh Farazestanian,
  • Babak Goodarzy,
  • Anita Alenabi

摘要

The distinction between endometrioid endometrial carcinoma (EEC) and serous endometrial carcinoma (SEC) is critical for treatment, but this proves difficult in poorly differentiated tumors. Molecular classification systems have been studied to streamline this task. TP53 mutations are associated with poor prognosis and aggressive behavior and are informally named “serous-like.” This study aims to compare the 2-year survival of high-grade EEC patients with TP53 mutations to those with SEC and to evaluate the prognostic implications of TP53 abnormalities. A retrospective cohort study was conducted on 62 patients with grade 3 EEC (n = 29) or SEC (n = 33) at Quaem Hospital, Mashhad, Iran, from March 2018 to December 2022. TP53 and mismatch repair status were determined using surrogate immunohistochemistry. Demographic data, clinical characteristics, and survival outcomes were analyzed. Kaplan–Meier survival curves and Cox proportional hazards regression models were used to assess 2-year overall survival (OS) and recurrence-free survival (RFS). Baseline characteristics were comparable, except for endometrial thickness, which was higher in EEC patients (p = 0.002). No significant differences were observed in 2-year OS (EEC3: 69% vs. SEC: 58%, p = 0.49) or local failure rates (EEC3: 31% vs. SEC: 29%, p = 0.870) between the two groups. Multivariate analysis identified CA-125 levels as a significant predictor of OS (HR = 1.00, 95% CI 1.001–1.005, p = 0.008). High-grade EEC with TP53 mutations exhibits a similarly unfavorable prognosis to SEC, which can be used to inform more intensive treatment strategies. Routine p53 immunohistochemistry testing is recommended to improve risk stratification and guide personalized treatment strategies, particularly in diagnostically challenging cases.