[Thoughts on the molecular characteristics of endometrial cancer in clinical diagnosis and treatment]

Molecular subtyping and detection of other molecular characteristics of endometrial cancer have been widely carried out and applied in clinical diagnosis and treatment. However, there are still many issues, including inconsistent molecular testing methods and the lack of high-quality evidence to guide standardized clinical diagnosis and treatment based on molecular characteristics. For molecular subtyping detection, it is recommended to conduct a comprehensive molecular subtyping assessment by combining immunohistochemistry (IHC) and next-generation sequencing (NGS). Clinically, the molecular subtyping of endometrial cancer, traditional pathological classification, and surgical pathological staging should be considered holistically, and individualized treatment plans should be formulated based on the latest available clinical evidence. POLE-mutant (POLEmut) endometrial cancer generally has a favorable prognosis, and immune checkpoint inhibitors (ICIs) may be an effective adjuvant treatment option for advanced POLEmut endometrial cancer. For stage Ⅲ and above mismatch repair-deficient (MMRd) endometrial cancer, postoperative paclitaxel plus carboplatin chemotherapy combined with ICIs and maintenance therapy are recommended. No specific molecular profile (NSMP) endometrial cancer should undergo risk stratification based on estrogen receptor (ER) expression level and pathological type, and high-risk NSMP should be treated with reference to p53-abnormal (p53abn) endometrial cancer. Precision diagnosis and treatment of endometrial cancer based on molecular characteristics are still in the stage of in-depth exploration and verification. Many issues remain to be resolved, such as whether MMRd endometrial cancer caused by MLH-1 methylation or mutations in MMR-encoding genes has consistent responses to ICIs, and how to predict treatment efficacy. The reduced cost and rapid popularization of high-throughput technologies, as well as the continuous expansion and improvement of evidence from prospective cohorts, will provide high-quality evidence for further refinement of molecular characteristics and risk stratification of endometrial cancer, and guide the implementation of precision treatment for this disease.