{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:28:58Z","timestamp":1783434538640,"version":"3.54.6"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007232","name":"Radiumhemmets Forskningsfonder","doi-asserted-by":"publisher","award":["181115"],"award-info":[{"award-number":["181115"]}],"id":[{"id":"10.13039\/501100007232","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the ability of demographic and sonographic variables and the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE) classification to predict preoperatively tumor recurrence or progression in women with endometrial cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study included 339 women with histologically confirmed endometrial cancer who underwent expert transvaginal ultrasound in a single center before surgery as part of the prospective International Endometrial Tumor Analysis 4 study or who were evaluated using the same protocol. The tumors were classified according to histotype, FIGO (International Federation of Gynecology and Obstetrics) grade and FIGO stage. In addition, molecular analysis was performed for classification into the four ProMisE subtypes: polymerase\u2010\u03f5 exonuclease domain mutations (<jats:italic>POLE<\/jats:italic> EDM), mismatch repair proteins deficiency (MMR\u2010D), protein 53 wild type (p53 wt) and protein 53 abnormal (p53 abn). Demographic and preoperative sonographic characteristics, tumor recurrence or progression and survival were compared between the ProMisE subgroups. Cox regression analysis was used to identify prognostic factors associated with recurrence or progression, using univariable models to study crude associations and multivariable models to study adjusted associations. Logistic regression and receiver\u2010operating\u2010characteristics (ROC)\u2010curve analysis were used to assess the predictive ability of the preoperative prognostic factors regarding recurrence or progression of cancer within 3\u2009years after surgery, and to compare their predictive ability to that of the European Society for Medical Oncology (ESMO) preoperative (based on depth of myometrial invasion, histotype and grade) and postoperative (based on histotype, grade, surgical stage and lymphovascular space invasion) risk classifications. In a separate subanalysis, cases were stratified according to ProMisE p53 abn status (present vs absent) and sonographic tumor size (anteroposterior (AP) diameter &lt;\u20092\u2009cm vs \u2265\u20092\u2009cm).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median follow\u2010up time from surgery was 58\u2009months (interquartile range, 48\u201371\u2009months; range, 0\u2013102\u2009months). Recurrence or progression of cancer occurred in 51\/339 (15%) women, comprising 14% of those with MMR\u2010D, 8% of those with <jats:italic>POLE<\/jats:italic> EDM, 9% of those with p53 wt and 45% of those with p53 abn ProMisE subtype. On multivariable analysis, age, waist circumference, ProMisE subtype and tumor extension and AP diameter on ultrasound were associated with tumor recurrence or progression. A multivariable model comprising ProMisE subtype, age, waist circumference and sonographic tumor extension and size (area under the ROC curve (AUC), 0.89 (95%\u2009CI, 0.85\u20130.93)) had comparable ability to predict tumor recurrence\/progression to that of a multivariable model comprising histotype, grade, age, waist circumference and sonographic tumor extension and size (AUC, 0.88 (95%\u2009CI, 0.83\u20130.92)), and better predictive ability than both the preoperative (AUC, 0.74 (95%\u2009CI, 0.67\u20130.82); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) and postoperative (AUC, 0.79 (95%\u2009CI, 0.72\u20130.86); <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01) ESMO risk classifications. Women with a combination of non\u2010p53 abn subtype and tumor size &lt;\u20092\u2009cm (164\/339 (48%)) had a very low risk (1.8%) of tumor recurrence or progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The combination of demographic characteristics, sonographic findings and ProMisE subtype had better preoperative predictive ability for tumor recurrence or progression than did the ESMO classification, supporting their use in the preoperative risk stratification of women with endometrial cancer. The combination of p53 status with ultrasound tumor size has the potential to identify preoperatively a large group of women with a very low risk of recurrence or progression. \u00a9 2020 The Authors. Ultrasound in Obstetrics &amp; Gynecology published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n\u2010 Legal Statement: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23573","type":"journal-article","created":{"date-parts":[[2020,12,14]],"date-time":"2020-12-14T15:39:29Z","timestamp":1607960369000},"page":"457-468","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Combination of Proactive Molecular Risk Classifier for Endometrial cancer (<scp>ProMisE<\/scp>) with sonographic and demographic characteristics in preoperative prediction of recurrence or progression of endometrial cancer"],"prefix":"10.1002","volume":"58","author":[{"given":"L. S. E.","family":"Eriksson","sequence":"first","affiliation":[{"name":"Department of Pelvic Cancer Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Women's and Children's Health Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Nastic","sequence":"additional","affiliation":[{"name":"Department of Pathology and Cytology Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Oncology\u2013Pathology Karolinska Institute  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1652-8235","authenticated-orcid":false,"given":"P. G.","family":"Lindqvist","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology S\u00f6dersjukhuset  Stockholm Sweden"},{"name":"Department of Clinical Science and Education Karolinska Institute, S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Imboden","sequence":"additional","affiliation":[{"name":"University of Bern, Department of Obstetrics and Gynecology University Hospital of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"J\u00e4rnbert\u2010Pettersson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education Karolinska Institute, S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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