Objective: To review and update current evidence on the molecular classification of endometrial carcinoma.
Materials and Methods: This narrative review was conducted through a selective synthesis of landmark studies and contemporary international guidelines on the molecular classification of endometrial carcinoma, including those from The Cancer Genome Atlas (TCGA), the World Health Organization (WHO), ESGO/ESTRO/ESP, FIGO, and the National Comprehensive Cancer Network (NCCN).
Results: Molecular classification categorizes endometrial carcinoma into four distinct subgroups: POLE-mut, dMMR/MSI, p53abn, and NSMP, each with unique biological features, prognostic implications, and therapeutic relevance. Among these, POLEmut tumors have the most favorable prognosis, whereas p53abn tumors are associated with the poorest outcomes; dMMR/MSI and NSMP tumors exhibit intermediate prognoses. The implementation of molecular classification in routine practice has been facilitated by immunohistochemical assessment of MMR proteins and p53, combined with targeted sequencing of the POLE exonuclease domain. Current international guidelines have incorporated molecular classification into risk stratification and treatment decision-making, supporting a more individualized approach to patient management.
Conclusion: Molecular classification provides important complementary information for prognostic evaluation and therapeutic decision-making in endometrial carcinoma. The appropriate integration of immunohistochemistry and molecular testing into routine pathology practice is expected to improve risk stratification and facilitate personalized management.