Photo Credit: iStock.com/Mohammed Haneefa Nizamudeen

Personalized care may hold the key as survival in advanced endometrial cancer remains poor regardless of surgery type or tumor subtype. 

Researchers conducted a retrospective study published in the June 2025 issue of European Journal of Obstetrics and Gynecology and Reproductive Biology to examine oncologic outcomes and prognostic factors across molecular subtypes of advanced or metastatic endometrial cancer treated with primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS).  

They reviewed records of individuals with endometrial cancer and either peritoneal carcinomatosis or bulky nodal metastasis who underwent surgery between September 2010 and February 2024. Survival outcomes were compared across 4 molecular subtypes [p53-mutant, MMR-deficient, NSMP, and POLE-mutant] and 2 surgical approaches, including PDS and NACT followed by IDS.  

The results showed that 51 individuals with stage IIIC–IVB endometrial cancer underwent surgery, with 36 (70.5%) receiving PDS and 15 (29.5%) receiving NACT followed by IDS. The FIGO stage IVB was present in 24 (66.6%) of the PDS group and 14 (93.3%) of the IDS group. Complete tumor removal was achieved in 83.3% of the PDS group vs 40% of the IDS group. Postoperative complication rates were similar. Among those with available molecular profiles, [p53-mutated] tumors were most common (36.1% PDS, 46.6% IDS), followed by MMR-deficient tumors (30.5% PDS, 26.6% IDS). No significant relationship was observed between the surgical approach and [disease-free survival (P = 0.523)] or [overall survival (OS) (P = 0.123)]. The molecular subtype also showed no predictive value for [disease-free survival (P = 0.397)] or [OS (P = 0.797)].  

Investigators concluded that oncologic outcomes for patients with advanced endometrial cancer had remained poor, that NACT continued to be a viable option for unresectable disease, and that a personalized approach considering histologic and molecular profiles may have improved survival. 

Source: ejog.org/article/S0301-2115(25)00227-1/abstract