Prognostic value of the TCGA molecular classification in uterine carcinosarcoma.

Abstract

BACKGROUND\nThe TCGA molecular groups of endometrial carcinoma are POLE-mutated (POLEmut), microsatellite-instable/mismatch repair-deficient (MSI/MMRd), TP53-mutated/p53-abnormal (TP53mut/p53abn) and no specific molecular profile (NSMP).\n\n\nOBJECTIVE\nPrognostic assessment of the TCGA groups in uterine carcinosarcoma (UCS).\n\n\nSEARCH STRATEGY\nSystematic review from January 2000 to January 2021.\n\n\nSELECTION CRITERIA\nStudies assessing the TCGA groups in UCS.\n\n\nDATA COLLECTION AND ANALYSIS\nProgression-free survival (PFS) and overall survival (OS) were assessed by Kaplan-Meier and Cox analyses (reference: TP53mut/p53abn group) and compared to endometrioid and serous carcinomas (original TCGA cohort), with a significant p-value<0.050 MAIN RESULTS: Five studies with 263 UCSs were included. Compared to TP53mut/p53abn UCSs, MSI/MMRd UCSs showed significantly better PFS (p<0.001) but similar OS (p=0.788), while NSMP UCSs showed similar PFS (p=0.936) and OS (p=0.240). Compared to their endometrioid/serous counterparts, NSMP and TP53mut/p53abn UCSs showed significantly worse PFS (p<0.001 and p=0.004) and OS (p<0.001 and p<0.001), while MSI/MMRd UCSs showed similar PFS (p=0.595) but significantly worse OS (p<0.001). The POLEmut group showed neither recurrences nor deaths in both UCS and endometrioid/serous carcinoma cohort.\n\n\nCONCLUSION\nPOLEmut UCSs show excellent prognosis, while TP53mut/p53abn and NSMP UCSs show a prognosis even worse than TP53mut/p53abn endometrioid/serous carcinomas. The prognosis of MSI/MMRd UCS remains to be defined.