GENERAL INTRODUCTION 19 1 AIMS AND OUTLINE OF THE THESIS Aims With only a moderate concordance between pre- and postoperative diagnosis, the creation of a more objective molecular classification by the TCGA was most welcome. However, routine molecular profiling comes with high costs, especially for low-income countries. With the introduction of these molecular subgroups, the prognostic relevance of tumor grading has gained less attention, as well as the easily accessible clinical and IHC biomarkers. It is questioned if the use of molecular biomarkers can be optimized by combining with IHC and clinical biomarkers. In this thesis we aim to evaluate the prognostic relevance of the current histomorphology, IHC and clinical biomarkers within the new era of molecular profiling in EC. Outline In chapter 2, the amount of preoperative endometrial tissue surface is evaluated to the degree of concordance with final low- and high-grade EC. Furthermore, it is determined whether discordance is influenced by sampling method and may impact outcome. In chapter 3, the prognostic relevance of molecular profiling in patients with low-grade EC is assessed. In chapter 4, the molecular and immunohistochemical features within mixed and pure uterine CCC are investigated and whether this affects clinical outcome. In chapter 5, the added prognostic relevance of preoperative IHC biomarkers to the ESMOESGO-ESTRO risk classification groups is investigated. In chapter 6, the relevance of using a three-tiered ER/PR risk model is investigated including the possible additional prognostic relevance within the four molecular subgroups. In chapter 7, the prognostic and predictive relevance of preoperative abnormal hematological parameters in patients with EC is evaluated. In chapter 8, a summary of the results of this thesis and future implications for clinical practice are discussed .
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