Identifying the frequency of mismatch repair deficiency in endometrial carcinoma in a tertiary care hospital
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20242468Keywords:
Endometrial carcinoma, Immunohistochemistry, Mismatch repair, Lynch syndrome, Microsatellite instabilityAbstract
Background: Mismatch repair deficiency (MMRd) is a pivotal genetic defect that significantly contributes to the pathogenesis of various cancers, particularly colorectal and endometrial cancers. The mismatch repair (MMR) system is essential for maintaining genomic stability by correcting base-base mismatches and insertion-deletion loops that occur during DNA replication. The aim of the study was to investigate the frequency and patterns of MMR protein deficiency in endometrial cancer and their association with clinical and pathological characteristics.
Methods: This cross-sectional observational study was conducted at the Department of Gynecological Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from March 2022 to February 2023. The study included all patients admitted with histologically confirmed endometrial carcinoma, diagnosed via endometrial fractional curettage or diagnostic D&C, who were admitted for surgical management.
Results: In this study of endometrial cancer, 49 participants were analyzed for mismatch repair (MMR) protein status. MMR deficiency (MMRd) was observed in 16 cases (32.7%). Among 16 MMR deficient EC, isolated single protein loss was in 5 (31.25%) and multiple loss was in 11(68.75%) cases. Family history of malignancy often correlated with MSH2 loss. MMRd was significantly associated with higher cancer stages. Immunohistochemistry proved effective for identifying MMR status, facilitating Lynch syndrome screening and subsequent clinical management. These findings underscore the importance of MMR testing in endometrial cancer for prognosis and treatment decisions.
Conclusions: This study underscores the importance of mismatch repair (MMR) protein status in the prognosis of endometrial cancer (EC).
References
Boland CR, Goel A. Microsatellite instability in colorectal cancer. Gastroenterol. 2010;138(6):2073-87.
Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med. 2003;348(10):919-32.
Coupez D, Hulo P, Touchefeu Y, Bossard C, Bennouna J. Pembrolizumab for the treatment of colorectal cancer. Expert Opinion on Biological Therapy. 2020 Mar 3;20(3):219-26.
Hause RJ, Pritchard CC, Shendure J, Salipante SJ. Classification and characterization of microsatellite instability across 18 cancer types. Nature Medi. 2016;22(11):1342-50.
Hampel H, Frankel WL, Martin E, Arnold M, Khanduja K, Kuebler P, et al. Screening for the Lynch syndrome (hereditary nonpolyposis colorectal cancer). N Engl J Medi. 2005;352(18):1851-60.
Le DT, Uram JN, Wang H, Bartlett BR, Kemberling H, Eyring AD, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509-20.
Hampel H, Frankel WL, Martin E, Arnold M, Khanduja K, Kuebler P, et al. Feasibility of screening for Lynch syndrome among patients with colorectal cancer. J Clin Oncol. 2008;26(35):5783-8.
de Freitas D, Aguiar FN, Anton C, de Almeida DC, Bacchi CE, Carvalho JP, et al. Clinicopathological characteristics of endometrial carcinomas according to DNA mismatch repair protein status. Heliyon. 2023;9(6).
Shen Z, Gu L, Mao D, Chen M, Jin R. Clinicopathological and prognostic significance of PD-L1 expression in colorectal cancer: a systematic review and meta-analysis. World J Surg Oncol. 2019;17:1-9.
Watkins JC, Yang EJ, Muto MG, Feltmate CM, Berkowitz RS, Horowitz NS, et al. Universal screening for mismatch-repair deficiency in endometrial cancers to identify patients with Lynch syndrome and Lynch-like syndrome. Int J Gynecol Pathol. 2017;36(2):115-127.
Stelloo E, Nout RA, Osse EM, Jürgenliemk-Schulz IJ, Jobsen JJ, Lutgens LC, 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.
Le DT, Durham JN, Smith KN, Wang H, Bartlett BR, Aulakh LK, et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017;357(6349):409-13.
Cancer Genome Atlas Research Network. Integrated genomic characterization of endometrial carcinoma. Nature. 2013;497(7447):67-73.
Salvesen HB, Haldorsen IS. Markers for individualised therapy in endometrial carcinoma. Lancet Oncol. 2018;19(12).
Vilar E, Gruber SB. Microsatellite instability in colorectal cancer-the stable evidence. Nat Rev Clin Oncol. 2010;7(3):153-62.
Boland CR, Sinicrope FA, Brenner DE, Carethers JM. Colorectal cancer prevention and treatment. Gastroenterol. 2000;118(6):1271-86.
Garg K, Shih K, Barakat R, Zhou Q, Iasonos A, Soslow RA. Endometrial carcinomas in women aged 40 years and younger: tumors associated with loss of DNA mismatch repair proteins comprise a distinct clinicopathologic subset. Am J Surg Pathol. 2009;33(12):1869-77.
Shih KK, Garg K, Levine DA, Kauff ND, Abu-Rustum NR, et al. Clinicopathologic significance of DNA mismatch repair protein defects and endometrial cancer in women 40 years of age and younger. Gynecol Oncol. 2011;123(1):88-94.
Gallo A, Catena U, Saccone G, Di Spiezio Sardo A. Conservative surgery in endometrial cancer. J Clin Med. 2021;11(1):183.
Buchanan DD, Tan YY, Walsh MD, Clendenning M, Metcalf AM, Ferguson K, et al. Tumor mismatch repair immunohistochemistry and DNA MLH1 methylation testing of patients with endometrial cancer diagnosed at age younger than 60 years optimizes triage for population-level germline mismatch repair gene mutation testing. J Clin Oncol. 2014;32(2):90-100.
Hampel H. Screening for Lynch syndrome in endometrial cancer. J Clin Oncol. 2006;24(18):4285-92.
Backes FJ, Haag J, Cosgrove CM, Suarez A, Cohn DE, Goodfellow PJ. Mismatch repair deficiency identifies patients with high‐intermediate–risk (HIR) endometrioid endometrial cancer at the highest risk of recurrence: A prognostic biomarker. Cancer. 2019;125(3):398-405.
Nagle CM, O'mara TA, Tan Y, Buchanan DD, Obermair A, Blomfield P, et al. Endometrial cancer risk and survival by tumor MMR status. J Gynecol Oncol. 2018;29(3).
Huang SW, Lin H, Huang CC, Ou YC, Fu HC, Tsai CC, Changchien CC, Wu CH. Comprehensive Clinicopathologic Analysis for Mismatch Repair Protein Expression in Unselected Endometrial Carcinoma Patients With an Emphasis on the Role of MLH1 Deficiency. Int J Gynecol Pathol. 2022;41(4):407-16.
Hampel H, Stephens JA, Pukkala E, Sankila R, Aaltonen LA, Mecklin JP, et al. Cancer risk in hereditary nonpolyposis colorectal cancer syndrome: later age of onset. Gastroenterol. 2005;129(2):415-21.
Stelloo E, Jansen AM, Osse EM, Nout RA, Creutzberg CL, Ruano D, et al. Practical guidance for mismatch repair-deficiency testing in endometrial cancer. Ann Oncol. 2017;28(1):96-102.
Zhao S, Chen L, Zang Y, Liu W, Liu S, Teng F, et al. Endometrial cancer in Lynch syndrome. Int J Cancer. 2022;150(1):7-17.
Nelson GS, Pink A, Lee S, Han G, Morris D, Ogilvie T, et al. MMR deficiency is common in high-grade endometrioid carcinomas and is associated with an unfavorable outcome. Gynecol Oncol. 2013;131(2):309-14.