Pathogenesis and Treatment of Endometrial Diseases

Dear Colleagues,

Endometrial diseases are the most common gynecological diseases in Western countries. Among them, the incidence of endometrial cancer (EC) and precancerous lesions has increased over recent years due to the rise in certain risk factors in the female population, especially obesity and aging. For decades, the pathological classification of EC has been based on the evaluation of histopathological features such as gradation, histotype, depth of myometrial invasion, and the involvement of contiguous structures. With the aim of overcoming the many limitations of this system, the Cancer Genome Atlas (TCGA) Research Network in 2013 updated the EC classification approach by integrating molecular characterization. It is now possible to divide EC into four subgroups, each with a different prognosis: ultramutated epsilon polymerase (POLE), hypermutated MSI, low copy number (CN) and elevated CN. Other genetic mutations were also analyzed with the aim of refining the characterization of these four subgroups. In recent years, numerous studies have tried to improve the clinical management of EC through the personalization of therapy including chemotherapy, radiotherapy, immune checkpoint inhibitors, and molecular targeted therapy. Promising results have been obtained by using various agents in monotherapy and in combination. In future years, the results of ongoing studies may result in these agents becoming the new standard of first-line treatment. Diseases of the endometrium include a variety of pathologies, and precancerous lesions have a significant impact in clinical practice. Molecular analysis could define the therapeutic strategy for these diseases, especially in premenopausal, nulliparous or pregnant women. This could allow them to undergo conservative therapy, and for radical surgery to be reduced. Although there is currently only sparse data available in the literature concerning these topics, future studies could obtain promising results.

This special issue of CEOG will focus on current knowledge regarding pathogenesis and personalized therapeutic strategies for patients with endometrial diseases, as well as consideration of future perspectives.

Dr. Andrea Giannini and Dr. Aris Raad Besharat
Guest Editors

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