The aggressiveness of mismatch repair (MMR) deficient
endometrial carcinomas was examined in a single institution retrospective study. Outcomes were similar for MMR proficient (n = 508) and deficient (n = 287)
carcinomas, identified by immunohistochemistry. In accordance with molecular classification based on The
Cancer Genome Atlas (TCGA),
tumors with abnormal p53 staining or polymerase-ϵ
exonuclease domain mutation were excluded from the MMR proficient subgroup, termed as "no specific molecular profile" (NSMP). Compared with NSMP (n = 218),
MMR deficiency (n = 191) was associated with poor disease-specific survival (p = 0.001).
MMR deficiency was associated with an increased risk of
cancer-related death when controlling for confounders (hazard ratio 2.0). In the absence of established clinicopathologic risk factors,
MMR deficiency was invariably associated with an increased risk of
cancer-related death in univariable analyses (hazard ratios ≥ 2.0). In contrast, outcomes for MMR deficient and NSMP subgroups did not differ when risk factors were present. Lymphatic dissemination was more common (p = 0.008) and the proportion of pelvic relapses was higher (p = 0.029) in the MMR deficient subgroup. Our findings emphasize the need for improved triage to adjuvant
therapy and new therapeutic approaches in MMR deficient
endometrial carcinomas.