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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2020.07.23    [Epub ahead of print]
The frequency of POLE-mutation in endometrial carcinoma and prognostic implications: a systemic review and meta-analysis
Alaa Salah Jumaah1 , Mais Muhammed Salim1 , Hawraa Sahib Al-Haddad2 , Katherine Ann McAllister3 , Akeel Abed Yasseen1
1Department of Pathology and Forensic Medicine, Faculty of Medicine, University of Kufa, Kufa, Iraq
2Al-Furat Al-Awsat Hospital, Kufa, Iraq
3School of Biomedical Science, University of Ulster, Northern Ireland, UK
Corresponding Author: Akeel Abed Yasseen ,Tel: +96-47811131586, Email: akeelyasseen@uokufa.edu.iq
Received: February 27, 2020;  Revised: July 18, 2020  Accepted: July 23, 2020.  Published online: September 2, 2020.
ABSTRACT

Background:
Endometrial carcinoma (EC) is classified into four distinct molecular subgroups including ultramutated DNA polymerase epsilon (POLE). POLE-mutated tumors have the best prognosis and are a promising target for immunotherapy. This meta-analysis consolidated the reported variation of POLE-mutant frequency and assessed prognostic value in EC.
Methods:
Internet searches explored scientific data bases: EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials databases. Data was extracted from eligible studies including: sample size, number of positive POLE-mutant cases, sequencing information, clinicopathologic data, and survival data. Meta-analysis and a random-effects model produced pooled estimates of POLE frequency and prognostic parameters using 95% confidence intervals (CI), hazard ratios (HR), and odd ratios (OR).
Results:
Six thousand three hundred and forty-six EC patient cases were pooled from 25 studies. The pooled proportion of POLE gene mutation in EC was 8.59% (95% CI, 7.01 to 10.32), of which 8.22% (95% CI, 6.27 to 10.42) were type I and 0.93% (95% CI, 0.34 to 1.81) type 2. Clinicopathologic data showed that POLE-mutated tumors are mostly endometrioid. They present at higher levels in earlier stages (I–II) of EC (89.51%; 95% CI, 81.11 to 95.66) at the highest grade III (51.53%; 95% CI, 36.08 to 66.84) with reduced myometrial invasion (OR, 1.48, 95% CI, 0.99 to 2.20). Survival analysis indicated favorable overall survival (HR, 0.90), disease-specific survival (HR, 0.41), and progression-free survival (HR, 0.23) for POLE mutant EC.
Conclusions:
Almost one-tenth of EC patients have POLE-mutated tumors. Given their improved prognostic potential, identifying the POLE mutation status is key for the management of EC patients.
Key Words: Endometrial carcinoma; POLE gene