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Abstract
Introduction. The new staging system for endometrial cancer proposed by FIGO in 2023 focuses on the inclusion of molecular genetic classifications. Surgery based on the molecular genetic subtype of the tumor is still relevant.
Materials and Methods. The study was conducted at the Botkin Hospital in 2023, from June to December. The observation group, consisting of 50 patients, endometrioid endometrial cancer of clinical stage I, who underwent immunohistochemical examination for the presence of p53abn and MMRd at the preoperative stage. All patients were divided into 3 subgroups: patients with MMRd+ tumors, with p53abn+ tumors, and with negative tests for MMRd and p53abn. Laparoscopic surgical intervention scopes included hysterectomy with ovaries, hysterectomy with ovaries and sentinel lymph node biopsy with ICG mapping, in case of unsuccessful indocyanine staining in the intermediate and high-risk groups, pelvic lymphadissection on the corresponding side, hysterectomy with ovaries and pelvic lymphadenectomy, hysterectomy with ovaries, pelvic and lumbar lymphadenectomy were performed. TNM 8th revision 2017, FIGO 2009, and 2023 classifications were used to stage patients. After the results of the histological examination were obtained, the correlation of lymph node involvement was analyzed, taking into account the stage of the disease according to FIGO 2009 and FIGO 2023 and the molecular genetic subtype of the tumor.
Results. The incidence of patients with the MMRd/p53abn negative subtype was 74 %, patients with the p53abn mutant type of expression — 8 %, the MMRd group was identified in 18 % of cases. For the molecular genetic subtype MMRd, the frequency of lymph node metastasis increased to 22.2 %, and for p53abn it increased up to 25 %.
Conclusion. At present, there is insufficient data to formulate new surgical approaches based on the new classification. Nevertheless, it seems reasonable to increase the volume of surgery in patients with p53abn, and surgical lymph node staging should be mandatory in patients with MMRd.
References
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