Relationship Between p53 and Recurrence in Endometrial Cancer

Öz

Objective: Tumor protein 53 (p53), were included in the new FIGO 2023 staging system. Tumor protein 53 (p53) was incorporated into the new FIGO 2023 staging system. This study aimed to assess recurrence rates, overall survival (OS), and progression-free survival (PFS) in endometrial cancer patients with p53 mutations treated in the radiation oncology clinic. Material and Method: 260 patients were included in the study. The patients were divided into 2 groups according to the p53 mutation: p53 abnormal (p53 mutant) and p53 wild type. The Kaplan-Meier method was used to evaluate OS and PFS. Survival rates; were compared in terms of p53 mutations. Patients who underwent surgery for EC between January 1, 2008, and January 1, 2023, were included if their postoperative pathology reports evaluated p53 mutations, and they were referred to the radiation oncology clinic. Results: In our study; OS of EC was 84.2%, PFS was 88.8%. Total of 29 patients (%11.2) with recurrence were detected in the follow-up of the patients. The OS of p53 wild type patients was 88.6% and p53 mutant patients was 61% (p<0.001). The PFS of p53 wild type patients was 91.8% and p53 mutant patients was 73.2% (p<0.001). When risk calculation was made, we found a 4.094-fold increased risk of recurrence in cases with p53 mutation (95% CI: 1.763-9.508). Based on p53 status, 41 patients (15.8%) were classified as the p53 mutant group, while 219 patients (84.2%) were categorized as the p53 wild-type group. Conclusion: As a result, the most important point we want to emphasize in the study is that vaginal cuff recurrence was observed in 3 patients with p53 mutation despite brachytherapy. We found that endometrial cancer with p53 mutation were associated with increased recurrence rate and decreased OS and PFS.

Anahtar Kelimeler

• Endometrial carcinoma
• p53
• Recurrence
• Survival

Kaynakça

1. 1. Xue Q, Che W, Xue L, et al. Causes of death in endometrial cancer survivors: A surveillance, epidemiology, and end result–based analysis. Cancer Medicine 2023;12(9):10917-30.
2. 2. Zhang X, Ba W, Zhao X, et al. Clinical-grade endometrial cancer detection system via whole-slide images using deep learning. Frontiers in Oncology 2022:12:1040238.
3. 3. Blüher M. Obesity: Global epidemiology and pathogenesis. Nature Reviews Endocrinology 2019;15(5):288-98.
4. 4. Dai Y, Wang Z, Wang J. Survival of microsatellite-stable endometrioid endometrial cancer patients after minimally invasive surgery: An analysis of the Cancer Genome Atlas data. Gynecologic Oncology 2020;158(1):92-98.
5. 5. Berek JS, Matias‐Guiu, Creutzberg, C, et al. FIGO staging of endometrial cancer: 2023. International Journal of Gynecology & Obstetrics 2023;162(2):383-94.
6. 6. Bilir F, Arıoz DT, Arıkan SE, et al. Relationship between molecular markers and lymphadenectomy and lymphovascular space invasion in endometrial cancer. Archives of Gynecology and Obstetrics 2023;308(3):941-946.
7. 7. Jamieson A, Thompson EF, Huvila J, et al. p53abn endometrial cancer: Understanding the most aggressive endometrial cancers in the era of molecular classification. International Journal of Gynecologic Cancer 2021;31(6).
8. 8. Makker V, MacKay H, Ray-Coquard I, et al. Endometrial cancer. Nat Rev Dis Primers 2021;7(1):88.

9. 9. Gultekin M, Dundar S, Kucukyildiz, et al. Survival of gynecological cancers in Turkey: Where are we at? Journal of Gynecologic Oncology 2017;28(6).
10. 10. Ozdemir CY, Telli EU, Oge T, et al. Ultrasonography, macroscopy, and frozen section: whıch is better for predicting deep myometrial invasıon in endometrial cancer? Revista da Associação Médica Brasileira 2023:69(10),e20230333.
11. 11. Eltabbakh GH, Shamonki J, Mount SL. Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors. Gynecologic Oncology 2005;99(2):309-12.
12. 12. Chen T, Jansen L, Gondos A, et al. Survival of endometrial cancer patients in Germany in the early 21st century: A period analysis by age, histology, and stage. BMC Cancer 2012;12:1-9.
13. 13. Kurosu H, Todo Y, Yamada R, et al. A BMI-category distribution pattern of intrinsic and treatment-related prognostic factors in endometrial cancer. Japanese Journal of Clinical Oncology 2021;51(5):722-27.
14. 14. Crosbie EJ, Kitson SJ, McAlpine, et al. Endometrial cancer. The Lancet 2022;399(10333):1412-28.
15. 15. World Health Organization. "World Health Organization BMI Classification." World Health Organization (2020). [Internet]. [cited 15 January 2024]. Available from:https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/body-mass-index
16. 16. Finucane MM, Stevens GA, Cowan MJ, et al. National, regional, and global trends in body-mass index since 1980: Systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9· 1 million participants. The Lancet 2011:377(9765):557-67.
17. 17. Stelloo E, Nout RA, Osse EM, et al. Improved risk assessment by integrating molecular and clinicopathological factors in early stage endometrial cancer, combined analysis of the PORTEC cohorts. Clin Cancer Res 2016;22(16):4215-4224.
18. 18. Raffone A, Travaglino A, Mascolo M, et al. TCGA molecular groups of endometrial cancer: Pooled data about prognosis. Gynecologic Oncology 2019;155(2):374-83.
19. 19. León-Castillo A, De Boer SM, Powell ME, et al. Molecular classification of the PORTEC-3 trial for high-risk endometrial cancer: Ipact on prognosis and benefit from adjuvant therapy. Journal of Clinical Oncology 2020;38(29):3388.
20. 20. Vermij L, Léon-Castillo A, Singh N, et al. p53 immunohistochemistry in endometrial cancer: Clinical and molecular correlates in the PORTEC-3 trial. Modern Pathology 2022;35(10):1475-83.
21. 21. Tresa A, Sambasivan S, Rema P, et al. Clinical profile and survival outcome of endometrial cancer with p53 mutation. Indian Journal of Surgical Oncology 2022;13(3):580-86.
22. 22. Shivkumar VB, Atram MA, Gangane NM. Expression of ER/PR receptor, Her-2/neu, Ki67 and p53 in endometrial carcinoma: Clinicopathological implication and prognostic value. Indian Journal of Gynecologic Oncology 2020;18:1-9.