CHAPTER 8 194 CONCLUSION A personalized risk stratification model including a combination of classic histomorphology, IHC markers, clinical markers and recently proposed molecular markers (Figure 4) appears to be the best approach in the diagnostic work-up of EC patients thereby reducing health costs. Thereafter, with the presented clinical decision tool an evidence based approach specific for primary and adjuvant treatment is proposed which may be tailored to the individual patient, giving her an optimal choice. Histology Grade FIGO stage Myometrial invasion LVSI L1CAM ER/PR POLEmut MSI/MMRd NSMP TP53mut/p53abn Age BMI CA125 Anemia IHC biomarkers Histomorphology Clinical markers Molecular biomakers Figure 4. Combining histomorphology, IHC biomarkers, clinical markers and molecular biomarkers should be the best approach in the diagnostic work-up for EC patients. Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; LVSI, lympho-vascular space invasion; IHC, immunohistochemical; L1CAM, L1 cell adhesion molecule; ER, Estrogen receptor; PR, progesterone receptor; BMI, Body mass index; CA125, cancer antigen; POLE, polymerase epsilon; MSI, microsatellite instable; MMRd, mismatch repair deficient; TP53, tumor protein 53
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