Prognostic Significance of Mismatch Repair Protein Expression and Its Association with Clinical Outcomes in Endometrial Cancer

Year 2025, Volume: 16 Issue: 2, 203 - 211, 18.08.2025

Ramazan Oğuz Yüceer , Mehmet Kıran , Serhan Can İscan

https://doi.org/10.22312/sdusbed.1681755

Abstract

Objective: This study aimed to evaluate the expression of mismatch repair (MMR) proteins in patients with endometrial cancer (EC), compare the findings with clinicopathological data, and investigate their prognostic implications. Materials and Methods: A total of 116 patients diagnosed with EC via endometrial biopsy or resection at Isparta City Hospital between March 1, 2017, and January 1, 2023, were included. Immunohistochemical analysis was performed to assess the expression of MMR proteins (MLH1, PMS2, MSH2, MSH6). Patients were classified as microsatellite stable (MSS) or microsatellite instable (MSI) based on MMR protein expression, and correlations with clinicopathological features and survival outcomes were analyzed. Results: Among the patients, 83.6% were classified as MSS and 16.4% as MSI. MSI was more frequently observed in patients under 60 years of age, with endometrioid type, low tumor grade, and hormone receptor positivity; however, these associations were not statistically significant. Estrogen receptor (ER) positivity, p53 mutation status, and microsatellite instability (MSI) were significant predictors of survival in endometrial cancer. The median overall survival (OS) was 31 months in the MSS group and 52 months in the MSI group, indicating a statistically significant difference (p = 0.002). Conclusion: MMR deficiency and MSI status are of prognostic significance in EC. MSI positivity is associated with longer survival and increased sensitivity to immunotherapy, highlighting its value as a clinically meaningful biomarker. Molecular classification can provide guidance for personalized treatment strategies.

Keywords

Endometrial cancer, Mismatch Repair Protein, Instability, Survival

Ethical Statement

This study was approved by the Ethics Committee of Süleyman Demirel University Medical Faculty (dated 12.01.2023, number: 9).

Endometrial Kanserde Mismatch Repair Protein Ekspresyonunun Prognostik Önemi ve Klinik Sonuçlarla İlişkisi

Abstract

Amaç: Bu çalışmada, endometrial kanser (EK) hastalarında MMR (Mismatch Repair) protein ekspresyonunu değerlendirmek, bu bulguları klinikopatolojik verilerle karşılaştırmak ve prognostik etkilerini incelemek amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, 1 Mart 2017 - 1 Ocak 2023 tarihleri arasında Isparta Şehir Hastanesi’nde endometrial biyopsi veya rezeksiyon ile EK tanısı alan 116 hasta dahil edilmiştir. MMR protein ekspresyonu (MLH1, PMS2, MSH2, MSH6) immünohistokimyasal yöntemle değerlendirilmiştir. MSS (mikrosatellit stabil) ve MSI (mikrosatellit instabil) olarak sınıflandırılan hastalar klinikopatolojik özellikler ve sağkalım açısından analiz edilmiştir. Bulgular: Hastaların %83.6’sı MSS, %16.4’ü MSI olarak saptanmıştır. MSI olguları daha çok <60 yaş, endometrioid tip, düşük tümör derecesi ve hormon reseptör pozitifliği ile ilişkilidir; ancak bu ilişkiler istatistiksel anlamlılık göstermemiştir. Endometrial kanserde östrojen reseptörü (ER) pozitifliği, p53 mutasyon durumu ve mikrosatellit instabilitesi (MSI), sağkalımın anlamlı belirleyicileri olarak saptanmıştır. Medyan genel sağkalım (OS), MSS grubunda 31 ay iken, MSI grubunda 52 ay olarak bulunmuş ve bu fark istatistiksel olarak anlamlıdır (p=0.002). Sonuç: MMR yetersizliği ve MSI durumu, EK’de prognostik öneme sahiptir. MSI pozitifliği, daha uzun sağkalım ve immünoterapiye duyarlılık açısından klinik olarak anlamlı bir biyobelirteçtir. Moleküler sınıflandırma, kişiselleştirilmiş tedavi stratejileri açısından yol gösterici olabilir.

Keywords

Endometrium kanseri, Mismatch Tamir Proteini, Kararsızlık, Sağkalım

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