Precision Adjuvant Treatment in Early-stage Endometrial Cancer: Integrating Clinicopathological, Molecular, and Emerging Biomarkers

Endometrial cancer is an area of cancer research where early detection has led to generally favorable survival outcomes, especially in FIGO stage I–II disease. Despite the predominance of early-stage diagnoses, the optimal selection of adjuvant therapies remains a subject of ongoing debate. Historically, decisions regarding post-surgical adjuvant treatment have relied on clinicopathological features such as tumor grade, lymphovascular space invasion (LVSI), and histological subtype. However, current risk stratification still fails to completely predict recurrence and survival, leaving some patients both under- and over-treated. With the advent of genomic profiling, specifically the TCGA-based molecular subgroups (POLE-mutated, MMR-deficient, p53-abnormal, and NSMP), research has illuminated new pathways for more refined prognostic classification. These biomarkers have demonstrated significant value in predicting outcomes, yet translating this molecular data into actionable clinical strategies remains challenging due to the lack of integrated predictive models.Despite the incorporation of molecular classification into current ESGO/ESTRO/ESP guidelines, substantial uncertainty remains regarding how molecular biomarkers should influence adjuvant treatment decisions in routine clinical practice, particularly among intermediate- and high-intermediate-risk patients. Nevertheless, standardized approaches that integrate both sets of parameters are still in development, with practical implementation barriers persisting in routine cancer care. Although molecular classifiers can stratify risk beyond traditional indices, questions persist about how best to leverage this information for treatment selection, balancing the benefits of de-escalation against the risk of undertreatment. There remains an unmet need for robust, clinically applicable tools that synthesize all relevant prognostic information to optimize individualized treatment.This Research Topic aims to advance the development of an integrated predictive framework that combines clinicopathological and molecular biomarkers to personalize adjuvant therapeutic decisions in early-stage endometrial cancer. The objectives are to critically evaluate the prognostic impact of paired clinical and molecular characteristics, determine whether such integration improves risk stratification compared to current criteria, and analyze how biomarker-driven approaches affect recurrence rates and survival outcomes. We also welcome studies addressing the clinical implementation of biomarker-guided management, including decision-impact studies, cost-effectiveness analyses, multidisciplinary implementation, and adoption in community practice. The intention is to support the creation of evidence-based models that enable clinicians to better identify patients who would benefit from adjuvant therapies, thus improving outcomes while minimizing unnecessary toxicity.To gather further insights in patients with FIGO stage I–II endometrial carcinoma who have undergone primary surgical management, we welcome articles from medical oncology, radiation oncology, gynecologic surgery, and gynecologic pathology addressing, but not limited to, the following themes:o Prognostic value of integrated clinicopathological and molecular risk factors.o Development and validation of multivariate predictive models or nomograms.o Comparative effectiveness of integrated versus traditional risk stratification systems.o Impact of molecular subgroup-guided adjuvant therapy on patient outcomes.o Practical considerations in the implementation of integrated decision-making frameworks.o Novel histopathological biomarkers and integrated pathology reporting for molecular risk stratification and adjuvant treatment selection.o Retrospective and prospective cohort analyses with available molecular and clinicopathological data.o Translation of predictive frameworks into clinical practice for personalized treatment planning.Please note that manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases that are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of the scope of this Research Topic. Topic editors: Swarupa Mitra, Martina Arcieri Source: https://www.frontiersin.org/research-topics/77430/precision-adjuvant-treatment-in-early-stage-endometrial-cancer-integrating-clinicopathological-molecular-and-emerging-biomarkers